Provider Demographics
NPI:1437698800
Name:GRIER, LAPORSHA (COSMETOLOGY INSTRUC1)
Entity Type:Individual
Prefix:
First Name:LAPORSHA
Middle Name:
Last Name:GRIER
Suffix:
Gender:F
Credentials:COSMETOLOGY INSTRUC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 HUDSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5020
Mailing Address - Country:US
Mailing Address - Phone:678-768-3790
Mailing Address - Fax:
Practice Address - Street 1:1534 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5020
Practice Address - Country:US
Practice Address - Phone:678-768-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOI0017851744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management