Provider Demographics
NPI:1942385901
Name:LAING, DENISE CLOUD (FNP-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:CLOUD
Last Name:LAING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837
Mailing Address - Country:US
Mailing Address - Phone:229-758-3385
Mailing Address - Fax:229-785-5937
Practice Address - Street 1:209 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837
Practice Address - Country:US
Practice Address - Phone:229-758-3385
Practice Address - Fax:229-785-5937
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA127193207Q00000X
GARN127193207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11DO266342OtherCLIA LAB NUMBER
GAGRP1474OtherMEDICARE GROUP NUMBER
GA642318048AMedicaid
GA642318048AMedicaid
GAQ51790Medicare UPIN