MEDICARE: MR. LODIAN ORLANDO THORPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN260245	GA

General Provider Information

NPI Number	:	1861088015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LODIAN ORLANDO THORPE

Provider Business Mailing Address
First Line	:	3200 PANTHERSVILLE RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-3831
Country	:	US
Telephone Number	:	404-212-3400
Fax Number	:	404-212-3202

Provider Business Practice Location Address
First Line	:	3200 PANTHERSVILLE RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-3831
Country	:	US
Telephone Number	:	404-212-3400
Fax Number	:	404-212-3202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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