Healthcare Provider Details

I. General information

NPI: 1104942994
Provider Name (Legal Business Name): LAURA A GRIFFAW MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD STE 800
ATLANTA GA
30342-1708
US

IV. Provider business mailing address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1137
  • Fax: 404-393-2142
Mailing address:
  • Phone: 770-991-2200
  • Fax: 770-991-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCOA09364-NM
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN226492
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269283.COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: