Provider Demographics
NPI:1730576349
Name:ROGERS, LAGONIA
Entity type:Individual
Prefix:
First Name:LAGONIA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24387
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-4387
Mailing Address - Country:US
Mailing Address - Phone:877-977-4630
Mailing Address - Fax:888-242-7469
Practice Address - Street 1:3740 CRANE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1233
Practice Address - Country:US
Practice Address - Phone:313-729-0021
Practice Address - Fax:888-242-7469
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic