MEDICARE: LAUREN ELIZABETH BOAG PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363AS0400X	Surgical Physician Assistant	12961	GA

General Provider Information

NPI Number	:	1831902923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELIZABETH BOAG PA

Provider Business Mailing Address
First Line	:	3286 NORTHSIDE PKWY NW UNIT 1000
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2223
Country	:	US
Telephone Number	:	404-841-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	3286 NORTHSIDE PKWY NW UNIT 1000
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2223
Country	:	US
Telephone Number	:	404-841-8450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	04/27/2025

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