Provider Demographics
NPI:1174676563
Name:AUSBORN, DENELLA LAZENBY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENELLA
Middle Name:LAZENBY
Last Name:AUSBORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HUGH HOWELL RD
Mailing Address - Street 2:SUITE 740
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4723
Mailing Address - Country:US
Mailing Address - Phone:770-938-4616
Mailing Address - Fax:770-938-4615
Practice Address - Street 1:4500 HUGH HOWELL RD
Practice Address - Street 2:SUITE 740
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4723
Practice Address - Country:US
Practice Address - Phone:770-938-4616
Practice Address - Fax:770-938-4615
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01000297OtherAMERIGROUP
GA2678878OtherMAGELLAN
GA33-1078488OtherNORTHLAKE MEDICAL RESEARC
GA6134630OtherUNITED BEHAVIORAL HEALTH
GA279069000OtherMAGELLAN
GA00891151AMedicaid
GA2441599995-02OtherMAGELLAN
GA2441599995-02OtherUNITED BEHAVIORAL HEALTH
GA001346OtherBLUECROSS BLUESHIELD OF G
GA7066282OtherAETNA, EL PASO
GA744015OtherAETNA
GA744015OtherAETNA, LEXINGTON
GA00891151AMedicaid