Individual
LAURA J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
115 EAGLE SPRING DR STE A200, STOCKBRIDGE, GA 30281-6486
(770) 474-0064
(770) 474-2998
Mailing address
115 EAGLE SPRING DR STE A200, STOCKBRIDGE, GA 30281-6486
(770) 474-0064
(770) 474-2998
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
RN067198
GA
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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