Wilson, Laura Renae

Wilson, Laura Renae is an sole proprietor health care provider with primary practice located at 5405 Memorial Dr Ste D , Stone Mountain GA 30083-3236. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Wilson, Laura Renae can be contacted via phone (404) 296-3800.

Contact Information

Primary practice address
5405 Memorial Dr Ste D Stone Mountain GA 30083-3236
Phone: (404) 296-3800
Fax: (404) 297-8753
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 004365 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 701633 Texas
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X RN247115 Georgia

Profile Details

NPI number 1104032218
LBN Legal business name Wilson, Laura Renae
Credentials MSN, APRN-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 15th, 2007
Last updated Mar 6th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104032218 NPPES
Texas Other 1821185299 NPI - BVCAA
Texas Other 1275620551 NPI - BVCAA
Texas MEDICAID 154467803 NPI - BVCAA
Texas Other 1649265646 NPI - BVCAA

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