Provider Demographics
NPI:1851190466
Name:HEAD, LAURA TALIAFERRO (PMHNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TALIAFERRO
Last Name:HEAD
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAMPBELL
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3194 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1434
Mailing Address - Country:US
Mailing Address - Phone:770-540-6842
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4651
Practice Address - Country:US
Practice Address - Phone:678-263-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121841363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health