Provider Demographics
NPI:1235293713
Name:LOVELL, JAMES A (MED,ATC, LAT, EMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:LOVELL
Suffix:
Gender:M
Credentials:MED,ATC, LAT, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4064
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302-4064
Mailing Address - Country:US
Mailing Address - Phone:404-614-1373
Mailing Address - Fax:404-614-1549
Practice Address - Street 1:755 HANK AARON DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1120
Practice Address - Country:US
Practice Address - Phone:404-614-1373
Practice Address - Fax:404-614-1549
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9142406146N00000X
GAAT0009532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer