Provider Demographics
NPI:1326467614
Name:JUDAH, LAUREN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LEWIS
Last Name:JUDAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 THORNTON RD.
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122
Mailing Address - Country:US
Mailing Address - Phone:770-739-9292
Mailing Address - Fax:770-948-9126
Practice Address - Street 1:915 THORTON RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122
Practice Address - Country:US
Practice Address - Phone:770-739-9292
Practice Address - Fax:770-948-9126
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83103208000000X
390200000X
NY288115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program