Healthcare Provider Details

I. General information

NPI: 1679794911
Provider Name (Legal Business Name): LYUBOV ZAVELINA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYUBOV ZAVELINA CRNA

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK STREET
MACON GA
31201
US

IV. Provider business mailing address

91 MORELAND AVE SE UNIT A
ATLANTA GA
30316-1336
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-6706
  • Fax: 478-633-5384
Mailing address:
  • Phone: 404-273-2490
  • Fax: 478-633-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN150738
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: