Provider Demographics
NPI:1043207814
Name:SOUTH, LORRI R (CRNA)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:R
Last Name:SOUTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:770-712-4616
Mailing Address - Fax:770-495-1585
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:770-712-4616
Practice Address - Fax:770-495-1585
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000947119HMedicaid
GA000947119BMedicaid
GA000947119GMedicaid
GA000947119EMedicaid
GA000947119CMedicaid
GA000947119DMedicaid
GA000947119FMedicaid
GA000947119EMedicaid
GA000947119HMedicaid
GA000947119BMedicaid
GA511I430189Medicare PIN