Provider Demographics
NPI:1770708000
Name:LAURSEN, GORM PORSMOSE (DC)
Entity type:Individual
Prefix:DR
First Name:GORM
Middle Name:PORSMOSE
Last Name:LAURSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4678
Mailing Address - Country:US
Mailing Address - Phone:404-289-0055
Mailing Address - Fax:
Practice Address - Street 1:1771 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4678
Practice Address - Country:US
Practice Address - Phone:404-289-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor