Provider Demographics
NPI:1689299935
Name:PRUSINSKI FERNUNG, LAUREN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PRUSINSKI FERNUNG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CHAFEE AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5810
Mailing Address - Country:US
Mailing Address - Phone:706-721-6228
Mailing Address - Fax:706-721-6220
Practice Address - Street 1:1004 CHAFEE AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5810
Practice Address - Country:US
Practice Address - Phone:706-721-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11957207R00000X
GA1689299935207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine