Provider Demographics
NPI:1366872335
Name:ROGERS, THAYRA
Entity type:Individual
Prefix:
First Name:THAYRA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N POINT CTR E
Mailing Address - Street 2:SUITE 461
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8269
Mailing Address - Country:US
Mailing Address - Phone:678-499-5636
Mailing Address - Fax:678-366-5001
Practice Address - Street 1:555 N POINT CTR E
Practice Address - Street 2:SUITE 461
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8269
Practice Address - Country:US
Practice Address - Phone:678-499-5636
Practice Address - Fax:678-366-5001
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028887114376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide