Individual
LASHAUN LEE VETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3278 MITCHELL BLVD, MOODY AFB, GA 31699-5645
(229) 257-1459
Mailing address
23 RD MTG, 3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-1459
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002972
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001360A
—
GA
01
—
1194898635
NPI
GA
01
—
667002
BLUE CROSS BLUE SHIELD GA
GA
01
—
970018519
RAILROAD MEDICARE
GA
Enumeration date
11/15/2006
Last updated
11/15/2017
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