Healthcare Provider Details

I. General information

NPI: 1700372190
Provider Name (Legal Business Name): CHANEL DONATO ROGERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CENTURY BLVD NE STE A
ATLANTA GA
30345-3397
US

IV. Provider business mailing address

1776 CENTURY BLVD NE STE A
ATLANTA GA
30345-3397
US

V. Phone/Fax

Practice location:
  • Phone: 678-974-2162
  • Fax: 888-533-9896
Mailing address:
  • Phone: 678-974-2162
  • Fax: 888-533-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: