Deja Shari Koenig, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN-NP282683 Issued in GA

Practice address

4400 Brownsville Rd Ste 105
Powder Springs, GA 30127-8902

Phone

(516) 830-5338

Fax

(470) 523-2573

NPI assigned

Jan 14, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Deja Shari Grant Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as apm

Quality

83.25

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24970/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• True North Health Navigation LLC

  dba DispatchHealth

  • Emergency Medicine Physician
  • Atlanta, GA
  • NPI 1578047536
  Medicare reassignment NPD
• Wellstreet of Georgia PC

  dba Piedmont Urgent Care

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Action Urgent Care Inc

  • Urgent Care Clinic/Center
  • San Jose, CA
  • NPI 1205186442
  NPD
• True North Health Navigation LLC

  dba Dispatch Health

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1740622133
  NPD
• Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Marietta, GA
  • NPI 1457320319
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1184264525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4034 OAK HILL RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355026",
            "telephone_number": "516-830-5338",
            "fax_number": "470-523-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 BROWNSVILLE RD STE 105",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301278902",
            "telephone_number": "516-830-5338",
            "fax_number": "470-523-2573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5885 Glenridge Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303285572",
            "country_code": "US",
            "telephone_number": "678-321-8546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1375 Blossom Hill Rd Ste 49",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951183806",
            "country_code": "US",
            "telephone_number": "408-645-7073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "DEJA",
        "middle_name": "SHARI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013548",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "APRN-NP282683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEJA",
            "last_name": "GRANT",
            "middle_name": "SHARI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Makayla Shaniece Kinlaw
• Angelo Adam Kisielewicz
• Kleiman LLC
• Klemako Medical Supplies Inc.
• Mark Allan Knautz, MEDICAL DOCTOR
• Carolus Korie
• L&D Medical Center, LLC
• Zinny Akunna Lambert, RN
• Afolasade Lawal
• Sherease Nicole Lawson, PCD,PCPD

• Nurse Practitioner in Powder Springs, GA
• Providers in Powder Springs, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.