Provider Demographics
NPI:1659571941
Name:LAVEAUX, KATHLEEN (MD,)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:LAVEAUX
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-623-8965
Mailing Address - Fax:770-623-4018
Practice Address - Street 1:698 DULUTH HWY STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7648
Practice Address - Country:US
Practice Address - Phone:770-822-0788
Practice Address - Fax:770-822-0326
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15-021207RH0003X
NY244794207RH0003X
GA074394207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162750AMedicaid
GA003162750BMedicaid
GA003162750BMedicaid