Healthcare Provider Details

I. General information

NPI: 1437288362
Provider Name (Legal Business Name): LAURA D HARTMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 COLUMBIA RD SUITE 103
MARTINEZ GA
30907-1450
US

IV. Provider business mailing address

4106 COLUMBIA RD SUITE 103
MARTINEZ GA
30907-1450
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-1440
  • Fax: 706-863-5418
Mailing address:
  • Phone: 706-863-1440
  • Fax: 706-863-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: