Provider Demographics
NPI:1093584187
Name:ST ONGE, LAUREN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ST ONGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 WOODSONG TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2829
Mailing Address - Country:US
Mailing Address - Phone:404-862-8066
Mailing Address - Fax:
Practice Address - Street 1:1860 ATKINSON RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5066
Practice Address - Country:US
Practice Address - Phone:186-010-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid
5874OtherHEALTH PARTNERS
568946544OtherBCBS