Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DS-028395-L | PA |
Y | 1223G0001X | General Practice | DS-028395-L | PA |
Y | 213EG0000X | General Practice | DS-028395-L | PA |
NPI | 1366555609 |
---|---|
Provider Name | Dr. Georgia Grace Rogers |
First Address | Aberdeen Proving Ground, MD 21005 |
Second Address | Aberdeen Proving Ground, MD 21005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 23/08/2018 |