Provider Demographics
NPI:1518442813
Name:GARFIELD, LORESE R
Entity Type:Individual
Prefix:
First Name:LORESE
Middle Name:R
Last Name:GARFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7243
Mailing Address - Country:US
Mailing Address - Phone:404-702-7871
Mailing Address - Fax:
Practice Address - Street 1:290 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7243
Practice Address - Country:US
Practice Address - Phone:404-702-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor