1982725974 NPI number — JOSE ANTONIO LAZZARINI MD

Table of content: JOSE ANTONIO LAZZARINI MD (NPI 1982725974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982725974 NPI number — JOSE ANTONIO LAZZARINI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZZARINI
Provider First Name:
JOSE
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAZZARINI
Provider Other First Name:
JOE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982725974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 N LAKE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUTEE NACOOCHEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30571-3930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-348-8909
Provider Business Mailing Address Fax Number:
706-348-8909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 COURT HOUSE SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30528-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-914-1864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2461 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 43602 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: D40158 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 101792 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , with the licence number: 2461 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , with the licence number: 43602 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , with the licence number: D40158 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , with the licence number: 101792 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00031 . This is a "LICENSE VOLUNTEER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2461 . This is a "LICENSE ACTIVE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".