Basic Information
Provider Information
NPI: 1629595590
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEHUNT
FirstName: LAUREN
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: DNP, NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 221 TECHNOLOGY PKWY NW
Address2:  
City: ROME
State: GA
PostalCode: 301651369
CountryCode: US
TelephoneNumber: 7622351000
FaxNumber:  
Practice Location
Address1: 14 CHEROKEE RD
Address2:  
City: CEDARTOWN
State: GA
PostalCode: 301254381
CountryCode: US
TelephoneNumber: 7707495400
FaxNumber: 7707499628
Other Information
ProviderEnumerationDate: 08/23/2017
LastUpdateDate: 11/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN210478GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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