Individual
LAUREN ELIZABETH ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
006698
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1107991
NCCPA CERTIFICATION
—
01
—
202I971141
MEDICARE PTAN
GA
Enumeration date
02/19/2013
Last updated
01/21/2016
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