Provider Demographics
NPI:1215472436
Name:RAZON, FAYE MARIZ LAURIO (PA-C)
Entity type:Individual
Prefix:MISS
First Name:FAYE MARIZ
Middle Name:LAURIO
Last Name:RAZON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE STE 160
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1160
Mailing Address - Country:US
Mailing Address - Phone:770-590-4180
Mailing Address - Fax:770-590-4186
Practice Address - Street 1:55 WHITCHER ST NE STE 160
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1160
Practice Address - Country:US
Practice Address - Phone:770-590-4180
Practice Address - Fax:770-590-4186
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008596363A00000X
ARPA-697363A00000X
363AS0400X
GA10083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical