Provider Demographics
NPI:1093327462
Name:METZDORF, LAURYN ASHLEIGH
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:ASHLEIGH
Last Name:METZDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2808
Mailing Address - Country:US
Mailing Address - Phone:478-290-6504
Mailing Address - Fax:
Practice Address - Street 1:816 S MAIN ST APT 164
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-3476
Practice Address - Country:US
Practice Address - Phone:478-290-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer