Basic Information
| Provider Information | |||||||||
| NPI: | 1104942994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFAW | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MSN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1279 HIGHWAY 54 W | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709912200 | ||||||||
| FaxNumber: | 7709911341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 JOHNSON FERRY RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042521137 | ||||||||
| FaxNumber: | 4043932142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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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 | 163W00000X | RN269283.COA1 | OH | N | Nursing Service Providers | Registered Nurse | 367A00000X | COA09364-NM | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | RN226492 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 2744338 | 05 | OH | MEDICAID |