Provider Demographics
NPI:1437356813
Name:THARP, LAURA L (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:THARP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOCTORS DR STE I
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2211
Mailing Address - Country:US
Mailing Address - Phone:912-383-6575
Mailing Address - Fax:912-383-6476
Practice Address - Street 1:100 DOCTORS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2210
Practice Address - Country:US
Practice Address - Phone:912-383-6575
Practice Address - Fax:912-383-6476
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072142207X00000X
SCLL30061207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148201AMedicaid
GA072142OtherMEDICAL LICENSE