Healthcare Provider Details

I. General information

NPI: 1629086715
Provider Name (Legal Business Name): LAURIE JOHNSTON SNEAD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD NE BLD D SUITE 360
ATLANTA GA
30342-1620
US

IV. Provider business mailing address

4499 CAIN CIR
TUCKER GA
30084-3102
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-1350
  • Fax:
Mailing address:
  • Phone: 770-491-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR5861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: