Provider Demographics
NPI:1134121528
Name:LAUREL MEDICAL MGMT PC
Entity Type:Organization
Organization Name:LAUREL MEDICAL MGMT PC
Other - Org Name:LAUREL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-635-1400
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30539-0005
Mailing Address - Country:US
Mailing Address - Phone:706-635-1400
Mailing Address - Fax:706-635-1411
Practice Address - Street 1:97 HEFNER ST
Practice Address - Street 2:STE 202
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8260
Practice Address - Country:US
Practice Address - Phone:706-635-1400
Practice Address - Fax:706-635-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP406Medicare ID - Type Unspecified