Provider Demographics
NPI:1508534389
Name:RADER, LAUREN G
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:G
Last Name:RADER
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 1:36 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-3568
Mailing Address - Country:US
Mailing Address - Phone:678-988-1370
Mailing Address - Fax:
Practice Address - Street 1:36 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-3568
Practice Address - Country:US
Practice Address - Phone:678-988-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner