Provider Demographics
NPI:1457899395
Name:EDEKER, LAUREN ASHLEY WAGES (PAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY WAGES
Last Name:EDEKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:WAGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2285 ASQUITH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-6008
Mailing Address - Country:US
Mailing Address - Phone:770-485-1554
Mailing Address - Fax:770-783-6775
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:STE 240
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-208-6008
Practice Address - Fax:678-208-6375
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008265363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical