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General NPI Number Information
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NPI Number | 1194259416
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Entity Type | Individual
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Provider Name | LAVIEL A FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 2000 HOWARD FARM DR STE 350
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City | CUMMING
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State | GA
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Zip | 30041-6075
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Country | US
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Telephone | 404-847-4230
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 HOWARD FARM DR STE 350
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City | CUMMING
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State | GA
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Zip | 30041-6075
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Country | US
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Telephone | 45-965-6704
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Fax | 404-847-4230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 96431
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 96431
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 2022011808
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License Number State | MO
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