Healthcare Provider Details

I. General information

NPI: 1306591888
Provider Name (Legal Business Name): SHAMETRA ROZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 MAIN ST E
SNELLVILLE GA
30078-3496
US

IV. Provider business mailing address

2118 MAIN ST E
SNELLVILLE GA
30078-3496
US

V. Phone/Fax

Practice location:
  • Phone: 678-748-3468
  • Fax: 678-894-1084
Mailing address:
  • Phone: 678-748-3468
  • Fax: 678-894-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: