Provider Demographics
NPI:1346348182
Name:KINGSLEY, LORI ANGELINA (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANGELINA
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DO
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 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-320-8689
Mailing Address - Fax:706-320-8609
Practice Address - Street 1:1800 10TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1513
Practice Address - Country:US
Practice Address - Phone:706-320-8689
Practice Address - Fax:706-320-8609
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine