Provider Demographics
NPI:1518312891
Name:JOHNSON, LAUREN MCKENZIE (MSPA, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:MCKENZIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:
Practice Address - Street 1:771 OLD NORCROSS RD STE 340
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4983
Practice Address - Country:US
Practice Address - Phone:678-376-7399
Practice Address - Fax:678-376-7398
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical