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Individual

LAURA DEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
105 CARNEGIE PL, STE 103, FAYETTEVILLE, GA 30214-3980
(770) 716-7999
Mailing address
105 CARNEGIE PL, STE 103, FAYETTEVILLE, GA 30214-3980
(770) 716-7999

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00964466
MEDICARE RAILROAD
GA
Enumeration date
10/23/2006
Last updated
12/19/2011
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