Provider Demographics
NPI:1538880067
Name:ROGERS, JADA LYNN (BADT FSD-T)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:LYNN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BADT FSD-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-5984
Mailing Address - Country:US
Mailing Address - Phone:414-484-1763
Mailing Address - Fax:
Practice Address - Street 1:1010 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-5984
Practice Address - Country:US
Practice Address - Phone:414-484-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty