Provider Demographics
NPI:1083804405
Name:FLEINER, LAURA B (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:FLEINER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:FLEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4849 PAULSEN ST STE 314
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4426
Mailing Address - Country:US
Mailing Address - Phone:912-354-3363
Mailing Address - Fax:912-354-3332
Practice Address - Street 1:4849 PAULSEN ST STE 314
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4426
Practice Address - Country:US
Practice Address - Phone:912-354-3363
Practice Address - Fax:912-354-3332
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1599363A00000X
GA005112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCJXHOtherMEDICARE
GA532267996AMedicaid
GA1599OtherTEMPORARY PERMIT NUMBER
GA1599OtherTEMPORARY PERMIT NUMBER