Healthcare Provider Details

I. General information

NPI: 1821847393
Provider Name (Legal Business Name): LAURA ELAINE CUPP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 TIPTON DR
DAHLONEGA GA
30533-1603
US

IV. Provider business mailing address

23 TIPTON DR
DAHLONEGA GA
30533-1603
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-6505
  • Fax: 706-867-0134
Mailing address:
  • Phone: 706-867-6505
  • Fax: 706-867-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN251131
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN251131
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN251131
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN251131
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP251131
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN251131
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: