Provider Demographics
NPI:1902064686
Name:LOVEJOY, LOURDES (CST/CFA)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:LOVEJOY
Suffix:
Gender:F
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 GLENRIDGE DR NE
Mailing Address - Street 2:STE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5574
Mailing Address - Country:US
Mailing Address - Phone:404-303-7703
Mailing Address - Fax:404-303-7706
Practice Address - Street 1:5881 GLENRIDGE DR NE
Practice Address - Street 2:STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-303-7703
Practice Address - Fax:404-303-7706
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00F700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant