Individual
LAURA UPHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1640 AIRPORT RD NW, STE 110, KENNESAW, GA 30144-7038
(678) 202-2074
(770) 590-1442
Mailing address
1984 PEACHTREE RD NW, STE 515, ATLANTA, GA 30309-5219
(404) 351-1754
(404) 351-7121
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
045698
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00559061
—
GA
Enumeration date
07/15/2006
Last updated
07/08/2007
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