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General NPI Number Information
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NPI Number | 1760669519
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Entity Type | Individual
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Provider Name | LORI ANN LITTLE MMSC PA, BS PT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1101 JUNIPER STREET SUITE 219
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City | ATLANTA
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State | GA
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Zip | 30309-7654
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Country | US
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Telephone | 678-480-4547
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 JUNIPER STREET SUITE 219
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City | ATLANTA
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State | GA
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Zip | 30309-7654
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Country | US
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Telephone | 678-480-4547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT006952
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005278
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License Number State | GA
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