Provider Demographics
NPI:1134957889
Name:LAVASSANI, GOLNESSA (DC)
Entity type:Individual
Prefix:DR
First Name:GOLNESSA
Middle Name:
Last Name:LAVASSANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SADDLE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8128
Mailing Address - Country:US
Mailing Address - Phone:678-973-7450
Mailing Address - Fax:
Practice Address - Street 1:1625 PLEASANT HILL RD STE 215
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5863
Practice Address - Country:US
Practice Address - Phone:470-299-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor