Provider Demographics
NPI:1649473497
Name:ROGERS, TOSHA LACRESHA (DO)
Entity type:Individual
Prefix:MS
First Name:TOSHA
Middle Name:LACRESHA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TOSHA
Other - Middle Name:LACRESHA
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:764 MEMORIAL DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1573
Mailing Address - Country:US
Mailing Address - Phone:678-705-4900
Mailing Address - Fax:678-705-5441
Practice Address - Street 1:764 MEMORIAL DR SE STE 101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1573
Practice Address - Country:US
Practice Address - Phone:678-705-4900
Practice Address - Fax:678-705-5441
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64644207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty