Provider Demographics
NPI:1730100223
Name:CULP, LAURIE N (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:N
Last Name:CULP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3226
Mailing Address - Country:US
Mailing Address - Phone:678-595-0062
Mailing Address - Fax:404-634-3482
Practice Address - Street 1:2440 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3226
Practice Address - Country:US
Practice Address - Phone:678-595-0062
Practice Address - Fax:404-634-3482
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2384103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00923018AMedicaid
GAS66729Medicare UPIN
GA68BBGFPMedicare ID - Type Unspecified