Healthcare Provider Details

I. General information

NPI: 1922705037
Provider Name (Legal Business Name): LAZINA PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY
ALPHARETTA GA
30005-4248
US

IV. Provider business mailing address

5835 REX RIDGE PKWY
REX GA
30273-5223
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax:
Mailing address:
  • Phone: 404-697-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1266
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number211401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: