Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN013559 | GA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN013559 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 067081 | GA |
NPI | 1083873871 |
---|---|
Provider Name | Dr. Kael A Rogers |
First Address | Norcross, GA 30092-2823 |
Second Address | Norcross, GA 30092-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 12/11/2013 |