Provider Demographics
NPI:1649469693
Name:LASSITER, MEREDITH A (DO)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:LASSITER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W CROSSVILLE RD STE 128
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7504
Mailing Address - Country:US
Mailing Address - Phone:770-587-0101
Mailing Address - Fax:
Practice Address - Street 1:625 W CROSSVILLE RD STE 128
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7504
Practice Address - Country:US
Practice Address - Phone:770-587-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10239207Q00000X
FLUO1175390200000X
GA64667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program