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General NPI Number Information
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NPI Number | 1215472436
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Entity Type | Individual
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Provider Name | FAYE MARIZ LAURIO RAZON PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE STE 160
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City | MARIETTA
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State | GA
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Zip | 30060-1160
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Country | US
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Telephone | 770-590-4180
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Fax | 770-590-4186
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Provider Business Mailing Address
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Address Line | 55 WHITCHER ST NE STE 160
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City | MARIETTA
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State | GA
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Zip | 30060-1160
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Country | US
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Telephone | 770-590-4180
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Fax | 770-590-4186
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110008596
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-697
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10083
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License Number State | GA
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