Provider Demographics
NPI:1104942994
Name:GRIFFAW, LAURA A (MSN, CNM)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:A
Last Name:GRIFFAW
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4550
Mailing Address - Country:US
Mailing Address - Phone:770-991-2200
Mailing Address - Fax:770-991-1341
Practice Address - Street 1:1100 JOHNSON FERRY RD STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1708
Practice Address - Country:US
Practice Address - Phone:404-252-1137
Practice Address - Fax:404-393-2142
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN269283.COA1163W00000X
OHCOA09364-NM367A00000X
GARN226492367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744338Medicaid
OHQ77533Medicare UPIN
OHNM03371Medicare PIN