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General NPI Number Information
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NPI Number | 1417932567
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Entity Type | Individual
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Provider Name | LAURIE EILEEN BIVINS RN, MSN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3515 DALLAS HWY SW STE C
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City | MARIETTA
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State | GA
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Zip | 30064-2095
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Country | US
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Telephone | 770-943-9150
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Fax | 770-218-0278
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Provider Business Mailing Address
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Address Line | 3515 DALLAS HWY SW STE C
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City | MARIETTA
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State | GA
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Zip | 30064-2095
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Country | US
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Telephone | 770-943-9150
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Fax | 770-218-0278
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 094302
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 85069
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License Number State | GA
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