Provider Demographics
NPI:1255154878
Name:PEGRIM, LAUREN AMELIA SMITH
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:AMELIA SMITH
Last Name:PEGRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:AMELIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:874 UNION AVE RM 325
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3514
Mailing Address - Country:US
Mailing Address - Phone:901-448-6128
Mailing Address - Fax:
Practice Address - Street 1:874 UNION AVE RM 325
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3514
Practice Address - Country:US
Practice Address - Phone:901-448-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program