Provider Demographics
NPI:1235629726
Name:HUNTER, LAUREL OLIVIA (MED)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:OLIVIA
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 ADDINGTON PL NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7140
Mailing Address - Country:US
Mailing Address - Phone:334-791-5451
Mailing Address - Fax:334-791-5451
Practice Address - Street 1:302 PONCE DE LEON PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5122
Practice Address - Country:US
Practice Address - Phone:404-932-0696
Practice Address - Fax:404-973-0756
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist