Provider Demographics
NPI:1831658244
Name:LOFTON, GERANDA (MS)
Entity Type:Individual
Prefix:
First Name:GERANDA
Middle Name:
Last Name:LOFTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MILGEN RD APT 1388
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-0919
Mailing Address - Country:US
Mailing Address - Phone:706-304-7117
Mailing Address - Fax:
Practice Address - Street 1:6300 MILGEN RD APT 1388
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-0919
Practice Address - Country:US
Practice Address - Phone:706-304-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor