Provider Demographics
NPI:1154831329
Name:MAIR, LAVERN A
Entity type:Individual
Prefix:
First Name:LAVERN
Middle Name:A
Last Name:MAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAVERN
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 LEGACY PARK DR
Mailing Address - Street 2:1521
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:954-864-3867
Mailing Address - Fax:
Practice Address - Street 1:615 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4325
Practice Address - Country:US
Practice Address - Phone:678-209-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032593363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health