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Individual

LAURA J LOGUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AOCNP

Contact information

Practice address
1411 LANEY WALKER BLVD # AN2206, MCG CANCER CENTER, AUGUSTA, GA 30912-0002
(706) 721-4811
(706) 721-0671
Mailing address
1411 LANEY WALKER BLVD. AN 2206, MCG CANCER CENTER, AUGUSTA, GA 30912-0004
(706) 721-4811
(706) 721-0671

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN196130 NP
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003104396B
GA
Enumeration date
01/22/2007
Last updated
03/17/2014
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