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General NPI Number Information
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NPI Number | 1205036829
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Entity Type | Organization
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Legal Business Name | ALLEN LAZERSON
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Dates
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Enumeration Date | 07/22/2007
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1234 POWERS FERRY RD SUITE 103
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City | MARIETTA
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State | GA
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Zip | 30067-9414
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Country | US
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Telephone | 770-951-8976
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Fax | 770-951-8988
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Provider Business Mailing Address
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Address Line | 1234 POWERS FERRY RD SUITE 103
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City | MARIETTA
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State | GA
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Zip | 30067-9414
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Country | US
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Telephone | 770-951-8976
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Fax | 770-951-8988
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALLEN LAZERSON
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Credential | DPM
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Telephone | 770-951-8976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | POD000496
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000496
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License Number State | GA
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