Provider Demographics
NPI:1215616412
Name:ANTONE, LOLEITA DIANE
Entity type:Individual
Prefix:
First Name:LOLEITA
Middle Name:DIANE
Last Name:ANTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6438 PHILLIPS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8931
Mailing Address - Country:US
Mailing Address - Phone:678-497-8896
Mailing Address - Fax:
Practice Address - Street 1:6438 PHILLIPS CREEK DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8931
Practice Address - Country:US
Practice Address - Phone:678-497-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician