Provider Demographics
NPI:1487734075
Name:LOFTERS-JONES, ENID IANTHE (MD)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:IANTHE
Last Name:LOFTERS-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ENID
Other - Middle Name:IANTHE
Other - Last Name:LOFTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 S 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4211
Mailing Address - Country:US
Mailing Address - Phone:770-227-5505
Mailing Address - Fax:770-412-7881
Practice Address - Street 1:503 S 8TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-227-5505
Practice Address - Fax:770-412-7881
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046884207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00835733HMedicaid
GA00835733HMedicaid
16BBCMMMedicare ID - Type Unspecified