Healthcare Provider Details

I. General information

NPI: 1578148656
Provider Name (Legal Business Name): RALPH C LOISEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 E PACES FERRY RD NE FL 16
ATLANTA GA
30326-1160
US

IV. Provider business mailing address

945 E PACES FERRY RD NE FL 16
ATLANTA GA
30326-1160
US

V. Phone/Fax

Practice location:
  • Phone: 404-844-8888
  • Fax:
Mailing address:
  • Phone: 404-844-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: