Provider Demographics
NPI:1417005661
Name:TAREN LAZZARI MSRNCS CORP
Entity Type:Organization
Organization Name:TAREN LAZZARI MSRNCS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-265-2772
Mailing Address - Street 1:4780 ASHFORD DUNWOODY RD
Mailing Address - Street 2:SUITE A-266
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5504
Mailing Address - Country:US
Mailing Address - Phone:770-265-2772
Mailing Address - Fax:
Practice Address - Street 1:265 LEDGEMONT CT NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2097
Practice Address - Country:US
Practice Address - Phone:770-265-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124127163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7288Medicare PIN