Individual
BENJAMIN LASSOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1650
(404) 712-2000
Mailing address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
6023
CT
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/09/2021
Last updated
09/19/2025
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