Healthcare Provider Details

I. General information

NPI: 1497735328
Provider Name (Legal Business Name): LAURIE MARTIN-KISER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 CHURCH STREET
ROYSTON GA
30662
US

IV. Provider business mailing address

819 CHURCH STREET
ROYSTON GA
30662
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-6177
  • Fax: 706-245-6242
Mailing address:
  • Phone: 706-245-6177
  • Fax: 706-245-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN135069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: