Provider Demographics
NPI:1245320977
Name:LAUBER, ALISON A (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:A
Last Name:LAUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:LAUBER
Other - Last Name:SHRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:321-401-1364
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:770 GRIESON TRAIL
Practice Address - Street 2:STE H
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6408
Practice Address - Country:US
Practice Address - Phone:770-252-5420
Practice Address - Fax:770-252-5417
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG22812Medicaid
GA000425752XMedicaid
SCG22812Medicaid
GA08CBBKTMedicare ID - Type Unspecified