Healthcare Provider Details

I. General information

NPI: 1023637923
Provider Name (Legal Business Name): LAUREN DAVISON WARREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

9010 STRADA STELL CT STE 203
NAPLES FL
34109-4427
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-4000
  • Fax:
Mailing address:
  • Phone: 239-254-1316
  • Fax: 239-254-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN264855
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11011400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: