Provider Demographics
NPI:1689338287
Name:MCQUEEN, DEANNA E
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:E
Last Name:MCQUEEN
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 1:800 TOWNE PARK DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5156
Mailing Address - Country:US
Mailing Address - Phone:912-556-0101
Mailing Address - Fax:
Practice Address - Street 1:800 TOWNE PARK DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5156
Practice Address - Country:US
Practice Address - Phone:912-556-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid