Healthcare Provider Details

I. General information

NPI: 1669945762
Provider Name (Legal Business Name): LAUREN ELIZABETH FELLOWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN ELIZABETH DILLON RN

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 10/27/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 BULLSBORO DR # 241
NEWNAN GA
30263-1069
US

IV. Provider business mailing address

388 BULLSBORO DR # 241
NEWNAN GA
30263-1069
US

V. Phone/Fax

Practice location:
  • Phone: 404-610-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN201921
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN201921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: