Provider Demographics
NPI:1437192846
Name:SHORES, LAURA (RRT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SHORES
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:HOMETOWN
Other - Middle Name:
Other - Last Name:HOMECARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:508 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6646
Mailing Address - Country:US
Mailing Address - Phone:229-551-0089
Mailing Address - Fax:229-228-1241
Practice Address - Street 1:508 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6646
Practice Address - Country:US
Practice Address - Phone:229-551-0089
Practice Address - Fax:229-228-1241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4596860001Medicare ID - Type UnspecifiedPROVIDER