Provider Demographics
NPI:1457633737
Name:OLIVER, LAURA STEMBRIDGE (MPA, PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:STEMBRIDGE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2502
Mailing Address - Country:US
Mailing Address - Phone:478-272-0203
Mailing Address - Fax:478-272-0223
Practice Address - Street 1:102 BOWLING LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2502
Practice Address - Country:US
Practice Address - Phone:478-272-0203
Practice Address - Fax:478-272-0223
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114423EMedicaid
GA003114423DMedicaid