Provider Demographics
NPI:1649517194
Name:BACHMAN, LAURA DAWN (MS PSYCOLOGY)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DAWN
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:MS PSYCOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2042
Mailing Address - Country:US
Mailing Address - Phone:478-213-7511
Mailing Address - Fax:478-745-9040
Practice Address - Street 1:472 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2042
Practice Address - Country:US
Practice Address - Phone:478-213-7511
Practice Address - Fax:478-745-9040
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126444AMedicaid