Healthcare Provider Details

I. General information

NPI: 1902896053
Provider Name (Legal Business Name): LAURA VERIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HIRAM DR BLDG B
HIRAM GA
30141-1844
US

IV. Provider business mailing address

51 HIRAM DR BLDG B
HIRAM GA
30141-1844
US

V. Phone/Fax

Practice location:
  • Phone: 678-945-8300
  • Fax: 770-445-2060
Mailing address:
  • Phone: 678-945-8300
  • Fax: 770-445-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number054043
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: