Provider Demographics
NPI:1093317430
Name:QUINN, LORA
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 STONE MOUNTAIN HWY STE D
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4691
Mailing Address - Country:US
Mailing Address - Phone:404-682-1862
Mailing Address - Fax:
Practice Address - Street 1:4765 STONE MOUNTAIN HWY STE D
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4691
Practice Address - Country:US
Practice Address - Phone:404-682-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist