Provider Demographics
NPI:1932631264
Name:LAMPERT, DANIELLE HAVIVAH (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:HAVIVAH
Last Name:LAMPERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 HIGHLAND LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3446
Mailing Address - Country:US
Mailing Address - Phone:770-630-7107
Mailing Address - Fax:
Practice Address - Street 1:2665 N DECATUR RD STE 240
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6136
Practice Address - Country:US
Practice Address - Phone:404-778-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12075363A00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer