Provider Demographics
NPI:1184888448
Name:MCCALL, LAURIE A (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:MCCALL
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:156 GEO DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-1603
Mailing Address - Country:US
Mailing Address - Phone:229-456-1956
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD EAST
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:229-589-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093653NP363LF0000X
GA093653363L00000X
GA096653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner