Provider Demographics
NPI:1063022481
Name:ELLIOTT, LAURA (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3895 CHEROKEE ST NW STE 400
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6732
Mailing Address - Country:US
Mailing Address - Phone:678-369-7755
Mailing Address - Fax:844-947-4544
Practice Address - Street 1:3895 CHEROKEE ST NW STE 400
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6732
Practice Address - Country:US
Practice Address - Phone:678-369-7755
Practice Address - Fax:844-947-4544
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN264851363LG0600X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine