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General NPI Number Information
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NPI Number | 1740234459
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Entity Type | Individual
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Provider Name | LAUREL ELISE ZOLLARS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 811 SALADO CREEK LN
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City | GEORGETOWN
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State | TX
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Zip | 78633-6009
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Country | US
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Telephone | 512-688-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 ARMINDA CT
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City | ALPHARETTA
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State | GA
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Zip | 30022-1591
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Country | US
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Telephone | 770-752-9132
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 044615
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 27967
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License Number State | AL
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