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General NPI Number Information
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NPI Number | 1396899167
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Entity Type | Individual
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Provider Name | LAURA J LOGUE AOCNP
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 1411 LANEY WALKER BLVD # AN2206 MCG CANCER CENTER
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City | AUGUSTA
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State | GA
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Zip | 30912-0002
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Country | US
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Telephone | 706-721-4811
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Fax | 706-721-0671
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Provider Business Mailing Address
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Address Line | 1411 LANEY WALKER BLVD. AN 2206 MCG CANCER CENTER
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-4811
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Fax | 706-721-0671
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN196130 NP
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License Number State | GA
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