Provider Demographics
NPI:1073291845
Name:LOFTIS, NICHELLE (CPT-NHA)
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:CPT-NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 COLUMBIA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6724
Mailing Address - Country:US
Mailing Address - Phone:404-490-2815
Mailing Address - Fax:
Practice Address - Street 1:3755 MEMORIAL DR
Practice Address - Street 2:SUITE C RM A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032
Practice Address - Country:US
Practice Address - Phone:404-490-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAZ7P6G3W8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy