Individual
REBECCA J. LOOMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 RIVER PL STE 100, BRASELTON, GA 30517-5610
(770) 848-6195
(770) 848-6196
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046984
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00822665B
—
GA
Enumeration date
08/23/2005
Last updated
11/09/2020
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