Provider Demographics
NPI:1932244928
Name:GARCIA, LAURA
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SHALLOWFORD DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-4128
Mailing Address - Country:US
Mailing Address - Phone:404-304-6947
Mailing Address - Fax:
Practice Address - Street 1:1077 JESSE JEWELL PKWY SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-6103
Practice Address - Country:US
Practice Address - Phone:770-536-3329
Practice Address - Fax:770-536-0462
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA270100103113341183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA270100103113341OtherSTATE CERTIFICATION