Individual
JASON PAUL LAURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 532-7179
(770) 534-1312
Mailing address
PO BOX 1076, GAINESVILLE, GA 30503-1076
(770) 532-7179
(770) 534-1312
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
004191
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360361027A
—
GA
05
—
360361027B
—
GA
Enumeration date
05/18/2006
Last updated
04/10/2012
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