Provider Demographics
NPI:1093967648
Name:FISHER, LAUREN MICHELE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11800 ATLANTIS PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1160
Mailing Address - Country:US
Mailing Address - Phone:770-360-8881
Mailing Address - Fax:770-255-2533
Practice Address - Street 1:11800 ATLANTIS PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1160
Practice Address - Country:US
Practice Address - Phone:770-360-8881
Practice Address - Fax:770-255-2533
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006140363A00000X
DCPA030559363A00000X
MDC04191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant