Healthcare Provider Details

I. General information

NPI: 1063321313
Provider Name (Legal Business Name): LAUREN TAYLOR ANDERSON CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DONEHOO ST
STATESBORO GA
30458-5120
US

IV. Provider business mailing address

959 EMIT DEAL RD
STATESBORO GA
30458-6797
US

V. Phone/Fax

Practice location:
  • Phone: 912-489-7827
  • Fax:
Mailing address:
  • Phone: 912-682-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC087009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: