Provider Demographics
NPI:1083271753
Name:PALMER, LAVERN N (NP)
Entity Type:Individual
Prefix:
First Name:LAVERN
Middle Name:N
Last Name:PALMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAVERN
Other - Middle Name:N
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4426 LUXEMBOURG DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5429
Mailing Address - Country:US
Mailing Address - Phone:404-906-2328
Mailing Address - Fax:
Practice Address - Street 1:5386 SNAPFINGER WOODS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4027
Practice Address - Country:US
Practice Address - Phone:404-906-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201872363LA2200X
GA201872363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE