Healthcare Provider Details

I. General information

NPI: 1871002154
Provider Name (Legal Business Name): ERIKA B LAUDERDALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 02/27/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PRINCE AVE STE 300
ATHENS GA
30606-5805
US

IV. Provider business mailing address

7714 POPLAR AVE STE 200
GERMANTOWN TN
38138-3941
US

V. Phone/Fax

Practice location:
  • Phone: 706-425-1470
  • Fax:
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-685-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: