Provider Demographics
NPI:1366610503
Name:PETER G. LAZARNICK, P.C.
Entity type:Organization
Organization Name:PETER G. LAZARNICK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LAZARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-834-7377
Mailing Address - Street 1:40 FOGGY BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-8047
Mailing Address - Country:US
Mailing Address - Phone:770-834-7377
Mailing Address - Fax:770-834-0251
Practice Address - Street 1:486 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2445
Practice Address - Country:US
Practice Address - Phone:770-834-7477
Practice Address - Fax:770-834-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1C GRP7356OtherMEDICARE GROUP
GA1C GRP7356OtherMEDICARE GROUP