=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215297486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA J LLOYD NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2012
-----------------------------------------------------
Last Update Date | 05/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 SPELMAN LN SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30314-4395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-270-5249
-----------------------------------------------------
Fax | 404-270-5257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5011 DUXFORD DR SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30082-5059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-759-3748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN134029
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------