Healthcare Provider Details

I. General information

NPI: 1083934608
Provider Name (Legal Business Name): LORI KATRINA DUCKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BULLSBORO DR
NEWNAN GA
30265-2182
US

IV. Provider business mailing address

949 ORIOLE DR SW
ATLANTA GA
30311-2422
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-3739
  • Fax:
Mailing address:
  • Phone: 404-752-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number068951
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: