Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009968 | GA |
NPI | 1740794866 |
---|---|
Provider Name | Dr. Jessica Lofgren |
First Address | Atlanta, GA 30312-7923 |
Second Address | Marietta, GA 30067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 14/06/2018 |