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NPI Code Detail

MEDICARE: LAURIE M. STAUB NP

MEDICARE: LAURIE M. STAUB NP
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
1363LF0000XFamily Nurse PractitionerAPRN-NP081873GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500020776OTHERGARR MEDICARE-GRP # CC4177

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
310053490OTHERGAAMERIGROUP
4335920OTHERGAWELLCARE

General Provider Information

NPI Number : 1790730042
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE M. STAUB NP
Provider Business Mailing Address
First Line : PO BOX 1060
Second Line :
City : OAKWOOD
State : GA
Zip : 30566-0018
Country : US
Telephone Number : 770-718-1122
Fax Number :
Provider Business Practice Location Address
First Line : 725 JESSE JEWELL PKWY SE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3834
Country : US
Telephone Number : 770-534-1986
Fax Number : 770-297-5645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 02/04/2026

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Directions to “ LAURIE M. STAUB NP” Practice Location

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