MEDICARE: MS. LAUREN ELIZABETH MASON RN, PNP

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	363LP0200X	Pediatric Nurse Practitioner	RN241691	GA

General Provider Information

NPI Number	:	1841741659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ELIZABETH MASON RN, PNP

Provider Business Mailing Address
First Line	:	2240 W PARK PLACE BLVD
Second Line	:	SUITE A
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:	770-771-5223

Provider Business Practice Location Address
First Line	:	2240 W PARK PLACE BLVD
Second Line	:	SUITE A
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:	770-771-5223

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	03/01/2017

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