Individual
MRS. LAURIE EILEEN BIVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CPNP
Contact information
Practice address
3515 DALLAS HWY SW STE C, MARIETTA, GA 30064-2095
(770) 943-9150
(770) 218-0278
Mailing address
3515 DALLAS HWY SW STE C, MARIETTA, GA 30064-2095
(770) 943-9150
(770) 218-0278
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
094302
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
85069
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000438688C
—
GA
Enumeration date
12/13/2005
Last updated
12/04/2025
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