Healthcare Provider Details

I. General information

NPI: 1033490206
Provider Name (Legal Business Name): LAUREN C KILPATRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN HOWE

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 PEACHTREE DUNWOODY RD NE SUITE 350
ATLANTA GA
30342-1725
US

IV. Provider business mailing address

5667 PEACHTREE DUNWOODY RD NE SUITE 350
ATLANTA GA
30342-1725
US

V. Phone/Fax

Practice location:
  • Phone: 800-655-2656
  • Fax: 412-822-7411
Mailing address:
  • Phone: 800-655-2656
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6091
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: