Provider Demographics
NPI:1942604251
Name:EPPS, LORI K
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:EPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LORI
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1510 N THORNTON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8517
Mailing Address - Country:US
Mailing Address - Phone:706-275-0543
Mailing Address - Fax:
Practice Address - Street 1:1510 N THORNTON AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8517
Practice Address - Country:US
Practice Address - Phone:706-275-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist