Healthcare Provider Details

I. General information

NPI: 1184040735
Provider Name (Legal Business Name): LAURA KATHLEEN CARMODY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 PEACHTREE ST NE
ATLANTA GA
30309-2433
US

IV. Provider business mailing address

1605 PEACHTREE ST NE
ATLANTA GA
30309-2433
US

V. Phone/Fax

Practice location:
  • Phone: 404-870-7789
  • Fax: 404-870-7809
Mailing address:
  • Phone: 404-870-7789
  • Fax: 404-870-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: