Provider Demographics
NPI:1033172382
Name:NAGASHIMA-WHALEN, LAUREN S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:S
Last Name:NAGASHIMA-WHALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:S
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:728 COBB ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2942
Mailing Address - Country:US
Mailing Address - Phone:706-548-3109
Mailing Address - Fax:706-543-4439
Practice Address - Street 1:728 COBB ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2942
Practice Address - Country:US
Practice Address - Phone:706-548-3109
Practice Address - Fax:706-543-4439
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060776207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1437298957OtherGROUP NPI
GA513522OtherWELLCARE
GA457017490AMedicaid
GA1033172382Medicare NSC
GA511I070073Medicare PIN