Jack A. Rogers Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

GA 017875 Issued in GA

Practice address

114 Plantation Ave
Cedartown, GA 30125-2370

Phone

(678) 901-0717

Fax

(678) 901-0718

NPI assigned

Jul 11, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cedar Creek Pediatrics

  • Pediatrics Physician
  • Cedartown, GA
  • NPI 1326284811
  NPD (past)
• Dr. Miniyars Pediatrics, P.C.

  • Pediatrics Physician
  • Rome, GA
  • NPI 1760651806
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1679571988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 PLANTATION AVE",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301252370",
            "telephone_number": "678-901-0717",
            "fax_number": "678-901-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 PLANTATION AVE",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301252370",
            "telephone_number": "678-901-0717",
            "fax_number": "678-901-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "JACK",
        "middle_name": "A.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "GA 017875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "625778716B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackie C Roberson, BS
• Joe Layne Roberts, PTA
• Amanda Robinson
• Karen Robinson, R.N.
• Todd Hunter Robinson, MD
• Sara Brabson Rogers, M.D.
• Yackinneia Roland, MA
• Norberto Rosado, MD
• Charis Hope Rudeseal, PHARMD
• Emalyn Samalio San Miguel

• Pediatrics Physician in Cedartown, GA
• Providers in Cedartown, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.