Provider Demographics
NPI:1053725184
Name:LOVEJOY FAMILY PRACTICE INC.
Entity type:Organization
Organization Name:LOVEJOY FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:678-545-6775
Mailing Address - Street 1:962 FOREST GLN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-8829
Mailing Address - Country:US
Mailing Address - Phone:678-545-6775
Mailing Address - Fax:
Practice Address - Street 1:1883 MCDONOUGH RD
Practice Address - Street 2:SUITE 200-D
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3516
Practice Address - Country:US
Practice Address - Phone:678-545-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128161261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109743AMedicaid
1114058203OtherPROVIDER NPI
1114058203OtherPROVIDER NPI