Healthcare Provider Details

I. General information

NPI: 1538165709
Provider Name (Legal Business Name): LAURA ELLEN PRADO DNP, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELLEN SMITH DNP, NP

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE STE 575
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

2001 PEACHTREE RD NE STE 575
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-0106
  • Fax: 404-350-0176
Mailing address:
  • Phone: 404-350-0106
  • Fax: 404-350-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN122652
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN122652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: