Provider Demographics
NPI:1043508146
Name:SHROYER, DANA LOUISE
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LOUISE
Last Name:SHROYER
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 1:7110 MCBRAYER RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-8957
Mailing Address - Country:US
Mailing Address - Phone:404-502-1357
Mailing Address - Fax:
Practice Address - Street 1:7110 MCBRAYER RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-8957
Practice Address - Country:US
Practice Address - Phone:404-502-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108245AMedicaid