Provider Demographics
NPI:1326778705
Name:HODGES SHUMAN, LAUREN
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:HODGES SHUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STONEWALL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:TIGER
Mailing Address - State:GA
Mailing Address - Zip Code:30576-2714
Mailing Address - Country:US
Mailing Address - Phone:912-665-8714
Mailing Address - Fax:
Practice Address - Street 1:123 STONEWALL ESTATES DR
Practice Address - Street 2:
Practice Address - City:TIGER
Practice Address - State:GA
Practice Address - Zip Code:30576-2714
Practice Address - Country:US
Practice Address - Phone:912-665-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional