Individual
MS. LAURA RENAE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS - CCC
Contact information
Practice address
52 BRIGHTLING LN, NEWNAN, GA 30265-5626
(770) 298-5892
Mailing address
52 BRIGHTLING LN, NEWNAN, GA 30265-5626
(770) 298-5892
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
YS001970
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
342657
WELLCARE
GA
Enumeration date
01/14/2007
Last updated
07/09/2007
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