Provider Demographics
NPI:1740729516
Name:MATHIS, LAUREN (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:411 TOWN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3487
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-854-2559
Practice Address - Street 1:411 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3487
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214012208000000X, 363L00000X, 363LP0200X
TX1003490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003187586DMedicaid
GA003187586EMedicaid
GA003187586FMedicaid