Individual
NIKOLOZ LAZARIASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
819 N FANT ST, ANDERSON, SC 29621-5717
(864) 261-1800
(864) 261-1856
Mailing address
819 N FANT ST, ANDERSON, SC 29621-5717
(864) 261-1800
(864) 261-1856
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22797
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000964807C
GA MEDICAID
GA
05
—
227971
—
SC
01
—
H622371153
MEDICARE PIN
SC
01
—
P00469507
RR MEDICARE
SC
Enumeration date
05/09/2006
Last updated
07/21/2022
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