Individual
LAURA L. MULLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-2861
(706) 721-1459
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 828-6410
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
033412
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000428447A
—
GA
05
—
G07281
—
SC
Enumeration date
08/30/2006
Last updated
11/30/2012
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