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General NPI Number Information
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NPI Number | 1912351347
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Entity Type | Individual
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Provider Name | DANIELLE RAFFAELLA LAZZARA D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 12455 BROADWELL RD STE 102-103
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City | MILTON
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State | GA
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Zip | 30004-6315
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Country | US
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Telephone | 770-375-6197
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Fax | 770-215-7577
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Provider Business Mailing Address
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Address Line | 12455 BROADWELL RD STE 102-103
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City | MILTON
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State | GA
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Zip | 30004-6315
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Country | US
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Telephone | 770-375-6197
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Fax | 706-253-3223
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 87864
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 87864
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License Number State | GA
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