Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 060776 | GA |
NPI | 1033172382 |
---|---|
Provider Name | Dr. Lauren S Nagashima-Whalen |
First Address | Athens, GA 30606-2942 |
Second Address | Athens, GA 30606-2942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 02/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437298957 | GROUP NPI (01) | GA |
457017490A | (05) | GA |
513522 | WELLCARE (01) | GA |