Provider Demographics
NPI:1699374199
Name:GADSON, LAUREN RILEY (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RILEY
Last Name:GADSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEDICAL CENTER BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7766
Mailing Address - Country:US
Mailing Address - Phone:678-312-3557
Mailing Address - Fax:
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7766
Practice Address - Country:US
Practice Address - Phone:678-312-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11574207X00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery