MEDICARE: LAUREN ACKERMAN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	PA00812	MS
2	363A00000X	Physician Assistant	PA00812	MS

General Provider Information

NPI Number	:	1598501504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ACKERMAN PA

Provider Business Mailing Address
First Line	:	111 S 23RD AVE APT 14
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-6015
Country	:	US
Telephone Number	:	985-515-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E HOSPITAL DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1310
Country	:	US
Telephone Number	:	601-475-9968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	04/10/2025

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Directions to “ LAUREN ACKERMAN PA” Practice Location

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