Healthcare Provider Details

I. General information

NPI: 1588830822
Provider Name (Legal Business Name): DR. LAUREN NOELLE COLLINS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NOELLE COLLINS MD

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 E MOREHEAD ST
CHARLOTTE NC
28207-1606
US

IV. Provider business mailing address

1524 E MOREHEAD ST
CHARLOTTE NC
28207-1606
US

V. Phone/Fax

Practice location:
  • Phone: 704-343-3400
  • Fax:
Mailing address:
  • Phone: 704-343-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number141675
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: