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Individual

DR. FLEETWOOD LOUSTALOT III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN, NP-C, PHD

Contact information

Practice address
4770 BUFORD HWY, ATLANTA, GA 30341-3717
(770) 488-5198
Mailing address
2 LAKEVIEW CV, HATTIESBURG, MS 39402-8528
(601) 264-2657

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R864143
MS
363LF0000X
Family Nurse Practitioner
Primary
RN206938
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0126734
MS
01
206938
LICENSE
GA
01
R864143
LICENSE NUMBER
MS
Enumeration date
05/04/2006
Last updated
10/09/2025
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