Healthcare Provider Details

I. General information

NPI: 1275581134
Provider Name (Legal Business Name): LAURETTE HO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD BLDG 1300
MARIETTA GA
30062
US

IV. Provider business mailing address

3225 SHALLOWFORD RD BLDG 1300
MARIETTA GA
30062
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax: 678-560-7185
Mailing address:
  • Phone: 678-560-7160
  • Fax: 678-560-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: