Provider Demographics
NPI:1053516575
Name:POPE, LAURA C (MED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:POPE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 COCHISE DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4330
Mailing Address - Country:US
Mailing Address - Phone:404-643-7999
Mailing Address - Fax:770-818-5743
Practice Address - Street 1:3623 COCHISE DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4330
Practice Address - Country:US
Practice Address - Phone:404-643-7999
Practice Address - Fax:770-818-5743
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA859219664AMedicaid