Provider Demographics
NPI:1336573179
Name:OGLESBY, LAUREN ELAINE SPRADLEY (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE SPRADLEY
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELAINE
Other - Last Name:SPRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0180
Mailing Address - Country:US
Mailing Address - Phone:912-655-5559
Mailing Address - Fax:
Practice Address - Street 1:807 S LAUREL ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-9273
Practice Address - Country:US
Practice Address - Phone:912-812-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61140207R00000X, 208000000X
SC86367207R00000X, 208000000X
GA89578208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics