Provider Demographics
NPI:1528132453
Name:ADLER, LAURENT
Entity type:Individual
Prefix:
First Name:LAURENT
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 DAVINCI CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7627
Mailing Address - Country:US
Mailing Address - Phone:770-417-2018
Mailing Address - Fax:770-417-2020
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:SUITE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-417-2018
Practice Address - Fax:770-417-2020
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47561207RG0300X
NY198503207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676677Medicaid
GA00902602BMedicaid
NY01676677Medicaid
GA00902602BMedicaid