Provider Demographics
NPI:1740234459
Name:ZOLLARS, LAUREL ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ELISE
Last Name:ZOLLARS
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 1:2050 ARMINDA CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1591
Mailing Address - Country:US
Mailing Address - Phone:770-752-9132
Mailing Address - Fax:
Practice Address - Street 1:811 SALADO CREEK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-6009
Practice Address - Country:US
Practice Address - Phone:512-688-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0446152085R0202X
AL279672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000838527CMedicaid
AL009940927Medicaid
AL009940929Medicaid
AL009940928Medicaid
AL009940926Medicaid
AL009940924Medicaid
CAES894YMedicare PIN
GA30BDMRJMedicare ID - Type Unspecified
AL009940924Medicaid
GA000838527CMedicaid
PA215284YA6CMedicare PIN
AL009940926Medicaid