Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1124591912 |
---|---|
Provider Name | Kortney Rogers |
First Address | Atlanta, GA 30374-2616 |
Second Address | Braselton, GA 30517-5600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2019 |
Last Update Date | 22/01/2021 |