Provider Demographics
NPI:1457821373
Name:OGLETREE, SHENA
Entity Type:Individual
Prefix:MRS
First Name:SHENA
Middle Name:
Last Name:OGLETREE
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 1:30 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7437
Mailing Address - Country:US
Mailing Address - Phone:404-764-0562
Mailing Address - Fax:
Practice Address - Street 1:1244 PARK VISTA DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5372
Practice Address - Country:US
Practice Address - Phone:404-215-6000
Practice Address - Fax:404-848-7965
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine