Provider Demographics
NPI:1144768235
Name:MAIN, LORI G (TECHNICIAN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:G
Last Name:MAIN
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4207
Mailing Address - Country:US
Mailing Address - Phone:501-985-9944
Mailing Address - Fax:501-985-6590
Practice Address - Street 1:2227 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4207
Practice Address - Country:US
Practice Address - Phone:501-985-9944
Practice Address - Fax:501-985-6590
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other