Provider Demographics
NPI:1336699719
Name:POWERS, LORI (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1672
Mailing Address - Country:US
Mailing Address - Phone:404-508-5012
Mailing Address - Fax:404-508-5560
Practice Address - Street 1:1458 CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1672
Practice Address - Country:US
Practice Address - Phone:404-501-6027
Practice Address - Fax:404-377-0550
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222284367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife