Provider Demographics
NPI:1902588452
Name:DALY, LOUREEN D (NA)
Entity Type:Individual
Prefix:
First Name:LOUREEN
Middle Name:D
Last Name:DALY
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:LOUREEN
Other - Middle Name:D
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 VINE STREET ATLANTA
Mailing Address - Street 2:ATLANTA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314
Mailing Address - Country:US
Mailing Address - Phone:678-896-8664
Mailing Address - Fax:
Practice Address - Street 1:164 VINE STREET ATLANTA
Practice Address - Street 2:ATLANTA
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:678-896-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor