Provider Demographics
NPI:1912046707
Name:PHILLIPS, ROGSBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROGSBERT
Middle Name:F
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5910 HILLANDALE DR
Mailing Address - Street 2:104
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1884
Mailing Address - Country:US
Mailing Address - Phone:678-418-3990
Mailing Address - Fax:678-418-3995
Practice Address - Street 1:5910 HILLANDALE DR
Practice Address - Street 2:104
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-1884
Practice Address - Country:US
Practice Address - Phone:678-418-3990
Practice Address - Fax:678-418-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA023493208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000245484AMedicaid
GA000245484AMedicaid