Provider Demographics
NPI:1598444218
Name:LASATER, JENNIE R (MS)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:R
Last Name:LASATER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9471
Mailing Address - Country:US
Mailing Address - Phone:404-840-1889
Mailing Address - Fax:
Practice Address - Street 1:6 EXECUTIVE PARK DR NE STE T-25
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2221
Practice Address - Country:US
Practice Address - Phone:888-924-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other