Provider Demographics
NPI:1730204579
Name:LOFTIS, DAVID E (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CENTURY PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3103
Mailing Address - Country:US
Mailing Address - Phone:470-242-1433
Mailing Address - Fax:470-235-1810
Practice Address - Street 1:2200 CENTURY PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3103
Practice Address - Country:US
Practice Address - Phone:470-242-1433
Practice Address - Fax:470-235-1810
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA805103T00000X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBBVRMedicare ID - Type Unspecified