Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 50971 | GA |
Y | 207RP1001X | Pulmonary Disease | 050971 | GA |
N | 207RS0012X | Sleep Medicine | 50971 | GA |
NPI | 1043205719 |
---|---|
Provider Name | Dr. John P Lazenby |
First Address | Athens, GA 30607-1400 |
Second Address | Athens, GA 30607-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 17/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00934953A | (05) | GA |
G31517 | (02) |