Healthcare Provider Details

I. General information

NPI: 1235044298
Provider Name (Legal Business Name): LAURYN WATERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE BUILDING 10, PIEDMONT CENTER, SUITE 100
ATLANTA GA
30305
US

IV. Provider business mailing address

3495 PIEDMONT ROAD NE BUILDING 10 PIEDMONT CENTER SUITE 100
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 770-758-7817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: