Healthcare Provider Details

I. General information

NPI: 1487223376
Provider Name (Legal Business Name): LAUREN JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODRUFF CIR NE STE P375
ATLANTA GA
30322-1020
US

IV. Provider business mailing address

100 WOODRUFF CIR NE STE P375
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-5655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA210718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: