Provider Demographics
NPI:1982704300
Name:ROGAN, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:ROGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3127 LENOX RD NE APT 43127
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6025
Mailing Address - Country:US
Mailing Address - Phone:404-788-2966
Mailing Address - Fax:
Practice Address - Street 1:3127 LENOX RD NE APT 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-6028
Practice Address - Country:US
Practice Address - Phone:404-788-2966
Practice Address - Fax:404-696-5705
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85-1251002OtherGEORGIA DEPARTMENT OF TREASURY
GAG00726Medicare UPIN
GA511G700201Medicare PIN
GA511I1080173Medicare UPIN