Provider Demographics
NPI:1104490051
Name:BOGANS, CURNESIA S
Entity type:Individual
Prefix:
First Name:CURNESIA
Middle Name:S
Last Name:BOGANS
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 1:3218 KESSOCK RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3115
Mailing Address - Country:US
Mailing Address - Phone:770-209-2798
Mailing Address - Fax:
Practice Address - Street 1:6015 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1343
Practice Address - Country:US
Practice Address - Phone:770-209-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist