Provider Demographics
NPI:1639299423
Name:LSFA CORP
Entity Type:Organization
Organization Name:LSFA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-LSFA CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RNFA
Authorized Official - Phone:770-932-8913
Mailing Address - Street 1:3531 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4352
Mailing Address - Country:US
Mailing Address - Phone:770-932-8913
Mailing Address - Fax:770-932-9580
Practice Address - Street 1:3531 HANOVER DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4352
Practice Address - Country:US
Practice Address - Phone:770-932-8913
Practice Address - Fax:770-932-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty