Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 080948 | GA |
N | 207QS0010X | Family Doctor - Sports Medicine | 80948 | GA |
NPI | 1013302280 |
---|---|
Provider Name | Torrance Christopher Laury |
First Address | Dunwoody, GA 30338-6476 |
Second Address | Dunwoody, GA 30338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 06/02/2020 |