Healthcare Provider Details

I. General information

NPI: 1215650114
Provider Name (Legal Business Name): LAURA LYNN BRADEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30044-7710
US

IV. Provider business mailing address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-5878
  • Fax:
Mailing address:
  • Phone: 678-312-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN283208
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN283208
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: