Provider Demographics
NPI:1295273530
Name:DEMANN, LARAYNE (EDS)
Entity type:Individual
Prefix:MS
First Name:LARAYNE
Middle Name:
Last Name:DEMANN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 AYERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3928
Mailing Address - Country:US
Mailing Address - Phone:404-395-2427
Mailing Address - Fax:706-282-6685
Practice Address - Street 1:179 AYERS CREEK DR
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3928
Practice Address - Country:US
Practice Address - Phone:404-395-2427
Practice Address - Fax:706-282-6685
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA365158252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency