Provider Demographics
NPI:1992351795
Name:FRANK, LAURIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:WHEELER CORRECTIONAL FACILITY- MEDICAL DEPARTMENT
Mailing Address - Street 2:195 N. BROAD STREET
Mailing Address - City:ALAMO
Mailing Address - State:GA
Mailing Address - Zip Code:30411
Mailing Address - Country:US
Mailing Address - Phone:912-568-1731
Mailing Address - Fax:912-568-1701
Practice Address - Street 1:WHEELER CORRECTIONAL FACILITY- MEDICAL DEPARTMENT
Practice Address - Street 2:195 N. BROAD STREET
Practice Address - City:ALAMO
Practice Address - State:GA
Practice Address - Zip Code:30411
Practice Address - Country:US
Practice Address - Phone:912-568-1731
Practice Address - Fax:912-568-1701
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109046363A00000X
GA1592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant