1326467614 NPI number — DR. LAUREN LEWIS JUDAH M.D.

Table of content: DR. LAUREN LEWIS JUDAH M.D. (NPI 1326467614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326467614 NPI number — DR. LAUREN LEWIS JUDAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDAH
Provider First Name:
LAUREN
Provider Middle Name:
LEWIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326467614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 THORNTON RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHIA SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-739-9292
Provider Business Mailing Address Fax Number:
770-948-9126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 THORTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHIA SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-739-9292
Provider Business Practice Location Address Fax Number:
770-948-9126
Provider Enumeration Date:
04/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  83103 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 288115 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)