Provider Demographics
NPI:1336382357
Name:VENNER, DENNIS QUENTIN (LMT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:QUENTIN
Last Name:VENNER
Suffix:
Gender:M
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 185
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-0185
Mailing Address - Country:US
Mailing Address - Phone:404-895-1499
Mailing Address - Fax:
Practice Address - Street 1:5908 FAIRBURN RD STE C
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2303
Practice Address - Country:US
Practice Address - Phone:404-402-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist