Provider Demographics
NPI:1841989241
Name:ROGERS, MARCUS DAVONTE
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:DAVONTE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S ARMED FORCES BLVD APT 4308
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-4846
Mailing Address - Country:US
Mailing Address - Phone:478-258-5318
Mailing Address - Fax:
Practice Address - Street 1:1000 S ARMED FORCES BLVD APT 4308
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4846
Practice Address - Country:US
Practice Address - Phone:478-258-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030079885376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide