Healthcare Provider Details

I. General information

NPI: 1851190466
Provider Name (Legal Business Name): LAURA TALIAFERRO HEAD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA CAMPBELL HEAD

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 04/01/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

IV. Provider business mailing address

3194 EDGEWATER DR
GAINESVILLE GA
30501-1434
US

V. Phone/Fax

Practice location:
  • Phone: 678-263-3080
  • Fax:
Mailing address:
  • Phone: 770-540-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN121841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: