Provider Demographics
NPI:1225357569
Name:BEANER, DORNISHA M (LMT)
Entity Type:Individual
Prefix:MS
First Name:DORNISHA
Middle Name:M
Last Name:BEANER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-0321
Mailing Address - Country:US
Mailing Address - Phone:770-841-6433
Mailing Address - Fax:
Practice Address - Street 1:3161 HOWELL MILL RD
Practice Address - Street 2:SUITE 410
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-0321
Practice Address - Country:US
Practice Address - Phone:404-352-4200
Practice Address - Fax:404-352-5200
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004498173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist