Healthcare Provider Details

I. General information

NPI: 1013695485
Provider Name (Legal Business Name): CAITLIN CRAIG LOFARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 10/24/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

3379 PEACHTREE RD NE STE 230
ATLANTA GA
30326-1020
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-4809
  • Fax:
Mailing address:
  • Phone: 404-478-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN244974
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN244974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: