Provider Demographics
NPI:1629492640
Name:NORMAN, LAUREN ELIZABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4220 GAUNTT RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0600
Mailing Address - Country:US
Mailing Address - Phone:478-719-6639
Mailing Address - Fax:
Practice Address - Street 1:4220 GAUNTT RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-0600
Practice Address - Country:US
Practice Address - Phone:478-719-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20000010192255A2300X
GAPT011383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer