Healthcare Provider Details

I. General information

NPI: 1124980164
Provider Name (Legal Business Name): LASHAINA LOVELACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 NEW FRANKLIN RD
LAGRANGE GA
30240-7701
US

IV. Provider business mailing address

1842 NEW FRANKLIN RD
LAGRANGE GA
30240-7701
US

V. Phone/Fax

Practice location:
  • Phone: 706-302-1256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN105300
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: