Provider Demographics
NPI:1043874209
Name:NELSON, LAURA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2965 EVANS OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4300
Mailing Address - Country:US
Mailing Address - Phone:252-626-1120
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 880
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1774
Practice Address - Country:US
Practice Address - Phone:404-255-2975
Practice Address - Fax:404-255-2276
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant