Healthcare Provider Details

I. General information

NPI: 1225962905
Provider Name (Legal Business Name): LAUREN STANCIL WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 EVANS TO LOCKS RD
EVANS GA
30809-3603
US

IV. Provider business mailing address

938 ELLIS LN
EVANS GA
30809-5528
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-1598
  • Fax: 706-854-8136
Mailing address:
  • Phone: 762-215-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET004523
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: