Healthcare Provider Details

I. General information

NPI: 1043703093
Provider Name (Legal Business Name): LORRAINE ELIZABETH MCDOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 BUFORD HWY
NORCROSS GA
30071
US

IV. Provider business mailing address

1153 TERRASOL RDG SW
LILBURN GA
30047-3093
US

V. Phone/Fax

Practice location:
  • Phone: 678-280-6630
  • Fax: 678-280-6635
Mailing address:
  • Phone: 224-595-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN251199
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN251199
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: