=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609882091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE HOLLY LOEFFLER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3014 N PATTERSON ST
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-242-0194
-----------------------------------------------------
Fax | 229-242-1785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3014 N PATTERSON ST
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-242-0194
-----------------------------------------------------
Fax | 229-242-1785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 024289
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------