Provider Demographics
NPI:1144255191
Name:WORD, LOIS (MSW)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:WORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WOODLAWN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3399
Mailing Address - Country:US
Mailing Address - Phone:678-360-0805
Mailing Address - Fax:678-814-4441
Practice Address - Street 1:216 WOODLAWN PARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3399
Practice Address - Country:US
Practice Address - Phone:678-360-0805
Practice Address - Fax:678-814-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA287201694AMedicaid