Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 032055 | GA |
NPI | 1033167689 |
---|---|
Provider Name | Dr. Laura Smith Lord |
First Address | Decatur, GA 30033-5918 |
Second Address | Decatur, GA 30033-5918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00636016D | (05) | GA |