Provider Demographics
NPI:1043019508
Name:MATTOX, LAUREN ASHLEY (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:MATTOX
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:MATTOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2275 STROUD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2812
Mailing Address - Country:US
Mailing Address - Phone:770-940-9262
Mailing Address - Fax:
Practice Address - Street 1:223 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2640
Practice Address - Country:US
Practice Address - Phone:770-991-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA254847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse