Healthcare Provider Details

I. General information

NPI: 1831196690
Provider Name (Legal Business Name): LAURA CONGER-MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CONGER M.D.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

IV. Provider business mailing address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6876
  • Fax: 706-272-6877
Mailing address:
  • Phone: 706-272-6876
  • Fax: 706-272-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42031
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number42031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: