Provider Demographics
NPI:1629365432
Name:TIMMONS, LAUREN BRIDGES (CPNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRIDGES
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1060
Mailing Address - Country:US
Mailing Address - Phone:404-785-6541
Mailing Address - Fax:404-785-1248
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-6541
Practice Address - Fax:404-785-1248
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187007363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110315CMedicaid
GA621057OtherWELLCARE
GA003110315DMedicaid
GA01455367OtherAMERIGROUP
GA621043OtherWELLCARE
GA621059OtherWELLCARE
GA621063OtherWELLCARE
GA003110315AMedicaid
GA003110315BMedicaid
GA003110315BMedicaid