=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104265016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERA LAFOSSE D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2013
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 SOUTHCREST DR STE 200
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-474-5302
-----------------------------------------------------
Fax | 770-474-1275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1035 SOUTHCREST DR STE 200
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-836-0136
-----------------------------------------------------
Fax | 404-850-8695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 006482
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 75308
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------