Healthcare Provider Details

I. General information

NPI: 1417005661
Provider Name (Legal Business Name): TAREN LAZZARI MSRNCS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 LEDGEMONT CT NE
ATLANTA GA
30342-2097
US

IV. Provider business mailing address

4780 ASHFORD DUNWOODY RD SUITE A-266
ATLANTA GA
30338-5504
US

V. Phone/Fax

Practice location:
  • Phone: 770-265-2772
  • Fax:
Mailing address:
  • Phone: 770-265-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN124127
License Number StateGA

VIII. Authorized Official

Name: TAREN LAZZARI
Title or Position: PRESIDENT
Credential:
Phone: 770-265-2772