Healthcare Provider Details

I. General information

NPI: 1912140278
Provider Name (Legal Business Name): LAURA HERINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN DR
DEMOREST GA
30535-4508
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 706-839-4092
  • Fax: 706-839-1970
Mailing address:
  • Phone: 770-219-8420
  • Fax: 706-839-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number079503
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79503
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number79503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: