MEDICARE: DR. DAVID E. LOFTIS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	805	GA
2	103TC0700X	Clinical Psychologist	805	GA
3	103TP2701X	Group Psychotherapy Psychologist	805	GA

General Provider Information

NPI Number	:	1730204579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID E. LOFTIS PH.D.

Provider Business Mailing Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3103
Country	:	US
Telephone Number	:	470-242-1433
Fax Number	:	470-235-1810

Provider Business Practice Location Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3103
Country	:	US
Telephone Number	:	470-242-1433
Fax Number	:	470-235-1810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/12/2016

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