Provider Demographics
NPI:1114382744
Name:PHILLIPS, LORIANN LEGGETT (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:LORIANN
Middle Name:LEGGETT
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:LORIANN
Other - Middle Name:LEGGETT
Other - Last Name:TEDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:404 OLD WHITAKER WAY
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-8723
Mailing Address - Country:US
Mailing Address - Phone:919-521-6223
Mailing Address - Fax:
Practice Address - Street 1:651 FAIR ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-536-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GAAT0033732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program