Provider Demographics
NPI:1245245620
Name:LORRAINE DRIVER
Entity Type:Organization
Organization Name:LORRAINE DRIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-207-5300
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-6807
Mailing Address - Country:US
Mailing Address - Phone:770-207-5300
Mailing Address - Fax:888-843-1625
Practice Address - Street 1:120 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2391
Practice Address - Country:US
Practice Address - Phone:770-207-5300
Practice Address - Fax:888-843-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842788030BMedicaid
GA842788030CMedicaid