Healthcare Provider Details

I. General information

NPI: 1053423244
Provider Name (Legal Business Name): JOHN BENNETT LOCHRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ATLANTA RD SE
SMYRNA GA
30080-8255
US

IV. Provider business mailing address

2815 PACES LAKE DR SE
ATLANTA GA
30339-4208
US

V. Phone/Fax

Practice location:
  • Phone: 770-436-8383
  • Fax: 770-436-8323
Mailing address:
  • Phone: 770-436-8383
  • Fax: 770-436-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number024969
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number024969
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: