Provider Demographics
NPI:1275095341
Name:GONZALEZ, LAURA MARIA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIA
Last Name:GONZALEZ
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 1:665 DULUTH HWY
Mailing Address - Street 2:STE 801
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8709
Mailing Address - Country:US
Mailing Address - Phone:678-799-6009
Mailing Address - Fax:
Practice Address - Street 1:755 WALTHER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8725
Practice Address - Country:US
Practice Address - Phone:770-962-4895
Practice Address - Fax:470-325-0193
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226051363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care