Provider Demographics
NPI:1447742150
Name:ROGERS, DEAUNIA SHONTAR
Entity type:Individual
Prefix:
First Name:DEAUNIA
Middle Name:SHONTAR
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 1:767 TERESA AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-5431
Mailing Address - Country:US
Mailing Address - Phone:229-449-8313
Mailing Address - Fax:
Practice Address - Street 1:767 TERESA AVE APT 107
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5431
Practice Address - Country:US
Practice Address - Phone:229-449-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009576104100000X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractor
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty