Provider Demographics
NPI:1295427672
Name:CHAVERS, LAVINIA DANIELLE
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:DANIELLE
Last Name:CHAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WESTRIDGE PKWY STE 714 #1525
Mailing Address - Street 2:STE 714 #1525
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:716-867-2200
Mailing Address - Fax:470-507-4310
Practice Address - Street 1:600 WESTRIDGE PKWY STE 714 #1525
Practice Address - Street 2:STE 714 #1525
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:716-867-2200
Practice Address - Fax:470-507-4310
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other