Provider Demographics
NPI:1851793210
Name:RHEIN, LAURA GOYDICH (PAAA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GOYDICH
Last Name:RHEIN
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3193 HOWELL MILL RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2129
Mailing Address - Country:US
Mailing Address - Phone:770-396-6190
Mailing Address - Fax:770-396-5541
Practice Address - Street 1:3193 HOWELL MILL RD NW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:770-396-6190
Practice Address - Fax:770-396-5541
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007300367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151299AMedicaid