=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053725184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVEJOY FAMILY PRACTICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2014
-----------------------------------------------------
Last Update Date | 06/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1883 MCDONOUGH RD SUITE 200-D
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30228-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-545-6775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 962 FOREST GLN
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30238-8829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-545-6775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PROVIDER
-----------------------------------------------------
Name | MRS. BARBARA JENKINS
-----------------------------------------------------
Credential | APRN FNP-BC
-----------------------------------------------------
Telephone | 678-545-6775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | RN128161
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------