Provider Demographics
NPI:1700214590
Name:STEWART, LAUREN PAULUS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:PAULUS
Last Name:STEWART
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1800 HOWELL MILL ROAD NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-240-9703
Mailing Address - Fax:404-240-9701
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 520
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-299-2223
Practice Address - Fax:404-292-8522
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2016-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA007017363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I977281Medicare PIN