Provider Demographics
NPI:1730680190
Name:SQUIRES JOHN, DIONNA
Entity Type:Individual
Prefix:
First Name:DIONNA
Middle Name:
Last Name:SQUIRES JOHN
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 1:1309 WELLBROOK CIR NE STE H
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3873
Mailing Address - Country:US
Mailing Address - Phone:678-263-2020
Mailing Address - Fax:
Practice Address - Street 1:1309 WELLBROOK CIR NE STE H
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3873
Practice Address - Country:US
Practice Address - Phone:678-263-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist