Provider Demographics
NPI:1659148757
Name:MARSHALL, LORTATIA (CNA)
Entity Type:Individual
Prefix:
First Name:LORTATIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:LORTATIA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:1212 MCCOY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-5927
Mailing Address - Country:US
Mailing Address - Phone:706-526-2173
Mailing Address - Fax:
Practice Address - Street 1:1212 MCCOY CHURCH RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-5927
Practice Address - Country:US
Practice Address - Phone:706-526-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030087992376K00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility