Provider Demographics
NPI:1013608181
Name:YANCEY, LAUREN BROOKE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROOKE
Last Name:YANCEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 INTERSTATE SOUTH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-6250
Mailing Address - Country:US
Mailing Address - Phone:678-454-7329
Mailing Address - Fax:678-454-7331
Practice Address - Street 1:150 INTERSTATE SOUTH DR STE 200
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-6250
Practice Address - Country:US
Practice Address - Phone:678-454-7329
Practice Address - Fax:678-454-7331
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty