Provider Demographics
NPI:1295120004
Name:DYAL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:LOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:631 CAMPBELL HILL ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1390
Mailing Address - Country:US
Mailing Address - Phone:770-422-0444
Mailing Address - Fax:770-422-4412
Practice Address - Street 1:631 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1390
Practice Address - Country:US
Practice Address - Phone:770-422-0444
Practice Address - Fax:770-422-4412
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily