Basic Information
| Provider Information | |||||||||
| NPI: | 1093831034 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JANICE H LOEFFLER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3014 N PATTERSON ST | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316021711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292420194 | ||||||||
| FaxNumber: | 2292421785 | ||||||||
| Practice Location | |||||||||
| Address1: | 3014 N PATTERSON ST | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316021711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292420194 | ||||||||
| FaxNumber: | 2292421785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOEFFLER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2292420194 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 024289 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.