Individual
MARY WESLEIGH LOURIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
5405 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3234
(404) 296-3800
Mailing address
5405 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3234
(404) 296-3800
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
290418
GA
Other
Enumeration date
09/09/2021
Last updated
03/16/2022
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