Individual
DR. KENNETH J LAZARUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,PHD
Contact information
Practice address
1250 HIGHWAY 54 W, STE. 102, FAYETTEVILLE, GA 30214-4545
(770) 719-2965
(770) 719-2963
Mailing address
1250 HIGHWAY 54 W, STE. 102, FAYETTEVILLE, GA 30214-4545
(770) 719-2965
(770) 719-2963
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
031058
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000406975D
—
GA
Enumeration date
06/29/2006
Last updated
02/06/2012
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