Healthcare Provider Details

I. General information

NPI: 1184442337
Provider Name (Legal Business Name): LORI REITER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 350
MARIETTA GA
30068-4396
US

IV. Provider business mailing address

4800 OLDE TOWNE PKWY STE 350
MARIETTA GA
30068-4396
US

V. Phone/Fax

Practice location:
  • Phone: 470-407-2407
  • Fax:
Mailing address:
  • Phone: 704-407-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN176475
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: