Provider Demographics
NPI:1801812607
Name:LONDON, LAURA LYNETTE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNETTE
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNETTE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 SPRINGVILLE STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-6163
Mailing Address - Country:US
Mailing Address - Phone:205-773-2075
Mailing Address - Fax:
Practice Address - Street 1:350 SPRINGVILLE STATION BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-6163
Practice Address - Country:US
Practice Address - Phone:205-773-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275726853OtherFACILITY NPI
TX67-1861OtherFACILITY MEDICARE NUMBER
TX1878423-01OtherFACILITY MEDICAID MEDICAID
TX1878423-01OtherFACILITY MEDICAID MEDICAID
TX1878423-01OtherFACILITY MEDICAID MEDICAID