Provider Demographics
NPI:1205275179
Name:HOOPER, LORENZO DEMOND (CSA)
Entity type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:DEMOND
Last Name:HOOPER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 BESRA DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7947
Mailing Address - Country:US
Mailing Address - Phone:404-805-9044
Mailing Address - Fax:
Practice Address - Street 1:593 BESRA DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-7947
Practice Address - Country:US
Practice Address - Phone:404-805-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4145246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant