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General NPI Number Information
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NPI Number | 1326441080
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Entity Type | Individual
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Provider Name | LAURA SHIRLENE DECKER APRN
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 4585 HARTLEY BRIDGE RD
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City | MACON
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State | GA
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Zip | 31216-5501
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Country | US
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Telephone | 478-781-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 517 SOUTHLAND TRL
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City | BYRON
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State | GA
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Zip | 31008-6062
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Country | US
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Telephone | 478-213-0223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN123457
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License Number State | GA
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