Provider Demographics
NPI:1043408578
Name:ROGERS, MAILIEN REED (DO)
Entity type:Individual
Prefix:DR
First Name:MAILIEN
Middle Name:REED
Last Name:ROGERS
Suffix:
Gender:
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:111H BUILDING 8 DOGWOOD AVENUE
Mailing Address - Street 2:PO BOX 4000 JAMES H QUILLEN VA MEDICAL CENTER
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3609
Practice Address - Street 1:500 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3992
Practice Address - Country:US
Practice Address - Phone:423-621-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2083207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055396Medicaid