Provider Demographics
NPI:1649355025
Name:SMITH, LAURA FRANCES (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:FRANCES
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:835 COGBURN AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1010
Mailing Address - Country:US
Mailing Address - Phone:770-422-8815
Mailing Address - Fax:770-422-8816
Practice Address - Street 1:2045 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1327
Practice Address - Country:US
Practice Address - Phone:770-502-0202
Practice Address - Fax:770-502-8822
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC363A00000X
GA4902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCJCRMedicare PIN