Laura Bordeu Pride, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7889 Issued in GA

Practice address

61 Whitcher St
Suite 2100
Marietta, GA 30060

Phone

(770) 423-0595

NPI assigned

Feb 17, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Laura Logan Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Quantum Radiology, PC

  • Diagnostic Radiology Physician
  • Marietta, GA
  • NPI 1366495988
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1134588270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STONEFOREST DR STE 130",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301894881",
            "telephone_number": "770-423-0595",
            "fax_number": "678-388-1627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 WHITCHER ST",
            "address_2": "SUITE 2100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-423-0595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDE",
        "first_name": "LAURA",
        "middle_name": "BORDEU",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-17",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "7889",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "7889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "LOGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lakimberly Nicole Price, M.D.
• Stacie Price, PSY.D.
• Tasha M Price, FNP
• Timothy R Price, D,C,
• Mysia Prickett, MSW
• Debra Karen Priesmeyer, RN
• Brittany Priest, DC
• Dana Prieto, FNP
• Primary Care Partners, PC
• Primary Medical Homecare LLC

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.