Healthcare Provider Details

I. General information

NPI: 1619791456
Provider Name (Legal Business Name): LAUREN GORING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 MEDLOCK BRIDGE RD
JOHNS CREEK GA
30097-2637
US

IV. Provider business mailing address

10730 MEDLOCK BRIDGE RD
JOHNS CREEK GA
30097-2637
US

V. Phone/Fax

Practice location:
  • Phone: 404-480-7362
  • Fax:
Mailing address:
  • Phone: 404-480-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: