Provider Demographics
NPI:1639166473
Name:LOHRENTZ, MARY L (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:LOHRENTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT., BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 302
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN061696367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000881955CMedicaid
GA000881955GMedicaid
GA000881955DMedicaid
GA000881955EMedicaid
GA000881955FMedicaid
GA000881955BMedicaid
GA511I430196Medicare PIN
GA000881955EMedicaid
GA000881955GMedicaid
GA000881955BMedicaid