Healthcare Provider Details

I. General information

NPI: 1316062656
Provider Name (Legal Business Name): LAUREN MEREDITH KUSHNER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

IV. Provider business mailing address

3851 WOODRIDGE WAY
TUCKER GA
30084-2158
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-6833
  • Fax:
Mailing address:
  • Phone: 404-272-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN131245NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: