Provider Demographics
NPI:1790378529
Name:WHITNEY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 SANDY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5798
Mailing Address - Country:US
Mailing Address - Phone:404-536-5830
Mailing Address - Fax:
Practice Address - Street 1:2580 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5798
Practice Address - Country:US
Practice Address - Phone:404-536-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist