Healthcare Provider Details

I. General information

NPI: 1639753882
Provider Name (Legal Business Name): LORI ALEXANDRA LITTLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 2ND AVE
ROCHELLE GA
31079-2046
US

IV. Provider business mailing address

636 2ND AVE
ROCHELLE GA
31079-2046
US

V. Phone/Fax

Practice location:
  • Phone: 229-365-2570
  • Fax: 229-365-2571
Mailing address:
  • Phone: 229-365-2570
  • Fax: 229-365-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN239397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: