Healthcare Provider Details

I. General information

NPI: 1043205719
Provider Name (Legal Business Name): JOHN P LAZENBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OLD JEFFERSON RD STE 200A
ATHENS GA
30607-1400
US

IV. Provider business mailing address

3320 OLD JEFFERSON RD STE 200A
ATHENS GA
30607-1400
US

V. Phone/Fax

Practice location:
  • Phone: 706-549-5560
  • Fax: 706-543-2593
Mailing address:
  • Phone: 706-549-5560
  • Fax: 706-543-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number050971
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number50971
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number50971
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: