Provider Demographics
NPI:1124119318
Name:DOVAN, LAURA M (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:DOVAN
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 1:420 E. 2ND AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161
Mailing Address - Country:US
Mailing Address - Phone:706-509-3278
Mailing Address - Fax:706-509-4608
Practice Address - Street 1:330 TURNER MCCALL BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-234-2324
Practice Address - Fax:706-234-1491
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA37BBGNRMedicare ID - Type UnspecifiedMEDICARE
GAH13894Medicare UPIN