Provider Demographics
NPI:1245344142
Name:THARPE, LAURIE C (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:C
Last Name:THARPE
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 1:330 HOSPITAL DR
Mailing Address - Street 2:STE 304
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-742-1010
Mailing Address - Fax:478-742-9666
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:STE 304
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-742-1010
Practice Address - Fax:478-742-9666
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00599134AMedicaid
F78354Medicare UPIN
GA00599134AMedicaid