Provider Demographics
NPI:1275213068
Name:LOFTY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:LOFTY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-499-7868
Mailing Address - Street 1:766 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5820
Mailing Address - Country:US
Mailing Address - Phone:678-499-7868
Mailing Address - Fax:
Practice Address - Street 1:766 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5820
Practice Address - Country:US
Practice Address - Phone:678-499-7868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care