Basic Information
| Provider Information | |||||||||
| NPI: | 1982369997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCARBROUGH | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 STONE PARK DR | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301881625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707159793 | ||||||||
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| Practice Location | |||||||||
| Address1: | 144 BILL CARRUTH PKWY STE 4200 | ||||||||
| Address2: | |||||||||
| City: | HIRAM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301413819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783244444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN236330 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.