Provider Demographics
NPI:1588658389
Name:LEVY, LAURA A (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2787
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-2787
Mailing Address - Country:US
Mailing Address - Phone:706-653-1102
Mailing Address - Fax:706-653-1230
Practice Address - Street 1:616 19TH ST
Practice Address - Street 2:DOCTORS HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-494-4282
Practice Address - Fax:706-494-4459
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA297382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30CDBJLMedicare ID - Type Unspecified
F23557Medicare UPIN