Healthcare Provider Details

I. General information

NPI: 1881681880
Provider Name (Legal Business Name): LAURA C CAUTHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 CHURCH ST NE
MARIETTA GA
30060-1358
US

IV. Provider business mailing address

574 CHURCH ST NE
MARIETTA GA
30060-1358
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-0285
  • Fax: 770-424-5037
Mailing address:
  • Phone: 770-427-0285
  • Fax: 678-564-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number056458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: