Healthcare Provider Details

I. General information

NPI: 1902205057
Provider Name (Legal Business Name): LAUREN KUBIK PEREZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

3323 13TH AVE
COLUMBUS GA
31904-7822
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8921
  • Fax:
Mailing address:
  • Phone: 706-587-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN186355
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN186355
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: