Basic Information
| Provider Information | |||||||||
| NPI: | 1497809420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARAONA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | KIM | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 116156 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303686156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705134000 | ||||||||
| FaxNumber: | 7709953495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1942 ATKINSON RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300435004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787750600 | ||||||||
| FaxNumber: | 6783775284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | RN047021 | GA | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000692986D | 01 | GA | PEACH STATE | OTHER | 00692986D | 01 | GA | WELLCARE | OTHER | 00692986D | 05 | GA | MEDICAID |