Provider Demographics
NPI:1871561159
Name:TSAKIRIS, LAURA A (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:TSAKIRIS
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 1:6610 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1542
Mailing Address - Country:US
Mailing Address - Phone:770-813-8742
Mailing Address - Fax:770-813-1776
Practice Address - Street 1:6610 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1542
Practice Address - Country:US
Practice Address - Phone:770-813-8742
Practice Address - Fax:770-813-1776
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDDTPMedicare ID - Type UnspecifiedMEDICARE
GAD31110Medicare UPIN