Healthcare Provider Details

I. General information

NPI: 1750678637
Provider Name (Legal Business Name): EMILY LAGERGREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WHITCHER ST NE STE 2100
MARIETTA GA
30060
US

IV. Provider business mailing address

60 CHASTAIN CENTER BLVD NW STE 66
KENNESAW GA
30144-5598
US

V. Phone/Fax

Practice location:
  • Phone: 770-423-0595
  • Fax: 678-391-5055
Mailing address:
  • Phone: 770-423-0595
  • Fax: 678-388-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number78383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: