Healthcare Provider Details

I. General information

NPI: 1821305590
Provider Name (Legal Business Name): LOIS ELAINE THORNTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 DARLING AVE
WAYCROSS GA
31501-5246
US

IV. Provider business mailing address

6228 PALMETTO WAY
BLACKSHEAR GA
31516-9310
US

V. Phone/Fax

Practice location:
  • Phone: 912-338-6438
  • Fax:
Mailing address:
  • Phone: 912-283-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN104839
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: