Provider Demographics
NPI:1386671998
Name:LASSITER, CHARLES COY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:COY
Last Name:LASSITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWER RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9411
Mailing Address - Country:US
Mailing Address - Phone:770-514-7550
Mailing Address - Fax:770-514-1390
Practice Address - Street 1:400 TOWER RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9411
Practice Address - Country:US
Practice Address - Phone:770-514-7550
Practice Address - Fax:770-514-1390
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052984207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine