Provider Demographics
NPI:1548297146
Name:MILLSAP, LORI W (NP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:W
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-3353
Mailing Address - Country:US
Mailing Address - Phone:770-387-4512
Mailing Address - Fax:770-334-3667
Practice Address - Street 1:491 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3353
Practice Address - Country:US
Practice Address - Phone:770-387-4512
Practice Address - Fax:770-334-3667
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN102683OtherADVANCED PRACTICE - NP
GA111968Medicare Oscar/Certification