Provider Demographics
NPI:1194259416
Name:FERNANDEZ, LAVIEL A (MD)
Entity type:Individual
Prefix:DR
First Name:LAVIEL
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HOWARD FARM DR STE 350
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6075
Mailing Address - Country:US
Mailing Address - Phone:045-965-6704
Mailing Address - Fax:404-847-4230
Practice Address - Street 1:2000 HOWARD FARM DR STE 350
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6075
Practice Address - Country:US
Practice Address - Phone:404-847-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96431207XS0117X, 207X00000X
MO2022011808207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery