Provider Demographics
NPI:1912634759
Name:SCHMIDT, LARA PARKER (PA-C)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:PARKER
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:GRACE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1336 HIGHWAY 54 W BLDG 500
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4574
Mailing Address - Country:US
Mailing Address - Phone:770-461-1238
Mailing Address - Fax:770-460-6610
Practice Address - Street 1:1336 HIGHWAY 54 W BLDG 500
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4574
Practice Address - Country:US
Practice Address - Phone:770-461-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant