=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174496434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN NICOLE WILSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 WOODRUFF CIRCLE SUITE 7130
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-778-1014
-----------------------------------------------------
Fax | 404-778-8593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 WOODRUFF CIRCLE SUITE 7130
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-778-1014
-----------------------------------------------------
Fax | 404-778-8593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 853
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------