Provider Demographics
NPI:1215748678
Name:LAVES, ANDREW
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:LAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 OLD BEN CARTER RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7673
Mailing Address - Country:US
Mailing Address - Phone:850-736-4833
Mailing Address - Fax:
Practice Address - Street 1:473 OLD BEN CARTER RD
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7673
Practice Address - Country:US
Practice Address - Phone:850-736-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical