MEDICARE: LAURA LEELLEN PRIEST APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP175508	GA

General Provider Information

NPI Number	:	1588308134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEELLEN PRIEST APRN

Provider Business Mailing Address
First Line	:	1503 PROFESSIONAL CT
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2566
Country	:	US
Telephone Number	:	706-281-8490
Fax Number	:	706-529-8487

Provider Business Practice Location Address
First Line	:	1503 PROFESSIONAL CT
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2566
Country	:	US
Telephone Number	:	706-281-8490
Fax Number	:	706-529-8487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	05/07/2026

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