Provider Demographics
NPI:1275273195
Name:HALLOCK, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11525 HAYNES BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-4822
Mailing Address - Country:US
Mailing Address - Phone:770-751-7198
Mailing Address - Fax:770-751-0800
Practice Address - Street 1:11525 HAYNES BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4822
Practice Address - Country:US
Practice Address - Phone:770-751-0800
Practice Address - Fax:770-751-7198
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104266208000000X
SCLL87955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics