=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407481864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHACHA LORQUET DNP, APRN, AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2020
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 RIVERSIDE PKWY STE 107
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-5926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-878-3215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 RIVERSIDE PKWY STE 107
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-5926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-878-3215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | RN304596
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | RN304596
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | RN304596
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2086H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Surgery) Physician
-----------------------------------------------------
License Number | RN304596
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------