Healthcare Provider Details

I. General information

NPI: 1043508146
Provider Name (Legal Business Name): DANA LOUISE SHROYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 MCBRAYER RD
CUMMING GA
30028-8957
US

IV. Provider business mailing address

7110 MCBRAYER RD
CUMMING GA
30028-8957
US

V. Phone/Fax

Practice location:
  • Phone: 404-502-1357
  • Fax:
Mailing address:
  • Phone: 404-502-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: