Healthcare Provider Details

I. General information

NPI: 1487629689
Provider Name (Legal Business Name): LAVERNE J ENRIQUE-LOFTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 REDDS CIR SW
LILBURN GA
30047-6525
US

IV. Provider business mailing address

3110 CLIFTON SPRINGS RD
DECATUR GA
30034-4600
US

V. Phone/Fax

Practice location:
  • Phone: 404-534-0035
  • Fax:
Mailing address:
  • Phone: 678-223-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN111252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: