Provider Demographics
NPI:1306875117
Name:TREFTS, LORI A (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:TREFTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:912-466-5503
Mailing Address - Fax:912-466-5553
Practice Address - Street 1:2500 STARLING ST.
Practice Address - Street 2:SUITE 503
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-0000
Practice Address - Country:US
Practice Address - Phone:912-466-5503
Practice Address - Fax:912-466-5553
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-002732084N0400X
GA660932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
190070OtherMEDCOST
NC5906014Medicaid
808506OtherPARTNERS
142R7OtherBCBS
7245850OtherAETNA
P00367375OtherRR MEDICARE
NC2054874OtherMEDICARE
WV3810008136Medicaid