=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962806075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENS CASE MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2014
-----------------------------------------------------
Last Update Date | 10/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HESTER DR
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-3389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-484-8286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HESTER DR
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-3389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-484-8286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GWENDOLYN H WATKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-484-8286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------