Healthcare Provider Details

I. General information

NPI: 1801759865
Provider Name (Legal Business Name): LAUREN ELIZABETH HENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GORDON ST
VALDOSTA GA
31601-4552
US

IV. Provider business mailing address

201 E GORDON ST
VALDOSTA GA
31601-4552
US

V. Phone/Fax

Practice location:
  • Phone: 850-521-0242
  • Fax: 850-521-1973
Mailing address:
  • Phone: 850-521-0242
  • Fax: 850-521-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: