Healthcare Provider Details

I. General information

NPI: 1205124906
Provider Name (Legal Business Name): LAURA RAYNE ROSENBERG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 W PACES FERRY RD NW
ATLANTA GA
30327-2306
US

IV. Provider business mailing address

1244 W PACES FERRY RD NW
ATLANTA GA
30327-2306
US

V. Phone/Fax

Practice location:
  • Phone: 404-844-1500
  • Fax:
Mailing address:
  • Phone: 404-844-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002691
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT002691
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: