Provider Demographics
NPI:1780297960
Name:MABRY, LORI ALEXANDER (PHIC, RMA, RPT, CPCT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ALEXANDER
Last Name:MABRY
Suffix:
Gender:F
Credentials:PHIC, RMA, RPT, CPCT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ALEXANDER
Other - Last Name:MABRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHIC, RMA, RPT, CPCT
Mailing Address - Street 1:124 VALLEY FARM LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1777
Mailing Address - Country:US
Mailing Address - Phone:678-471-6983
Mailing Address - Fax:678-403-2310
Practice Address - Street 1:4929 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5323
Practice Address - Country:US
Practice Address - Phone:678-471-6983
Practice Address - Fax:678-403-2310
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAY8J9Y5Z9374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide