Healthcare Provider Details

I. General information

NPI: 1245128388
Provider Name (Legal Business Name): GEORGIA LONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5156 THEODORE ST
MAPLE HEIGHTS OH
44137-1330
US

IV. Provider business mailing address

5156 THEODORE ST
MAPLE HEIGHTS OH
44137-1330
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-7995
  • Fax:
Mailing address:
  • Phone: 216-903-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: