Provider Demographics
NPI:1831196690
Name:CONGER-MOORE, LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:CONGER-MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CONGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-272-6876
Mailing Address - Fax:706-272-6877
Practice Address - Street 1:1200 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-272-6876
Practice Address - Fax:706-272-6877
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42031207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000788785AMedicaid
GA000788785AMedicaid
GAG67527Medicare UPIN