MEDICARE: DR. LAUREN SOPHIE MARX PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY004134	GA

General Provider Information

NPI Number	:	1952820052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN SOPHIE MARX PHD

Provider Business Mailing Address
First Line	:	2700 PACES FERRY RD SE UNIT 502
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-7904
Country	:	US
Telephone Number	:	678-360-2736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 LAWRENCEVILLE HWY STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3267
Country	:	US
Telephone Number	:	404-692-3275
Fax Number	:

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

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	09/11/2017

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