Provider Demographics
NPI:1477708089
Name:DOCTOR, LORENA (MD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:MD
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 512
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-0512
Mailing Address - Country:US
Mailing Address - Phone:440-554-4601
Mailing Address - Fax:
Practice Address - Street 1:501 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5007
Practice Address - Country:US
Practice Address - Phone:229-468-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23410207RC0001X
GA73221207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology