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NPI Code Detail

MEDICARE: LAURA LUCAS YOUNGBLOOD CPNP

MEDICARE: LAURA LUCAS YOUNGBLOOD CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerRN112888GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538128988
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA LUCAS YOUNGBLOOD CPNP
Provider Business Mailing Address
First Line : 2220 N DRUID HILLS RD NE # ND
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3117
Country : US
Telephone Number : 404-785-1675
Fax Number : 770-534-8998
Provider Business Practice Location Address
First Line : 2220 N DRUID HILLS RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3117
Country : US
Telephone Number : 404-785-1675
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 10/09/2024

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