Provider Demographics
NPI:1912351347
Name:LAZZARA, DANIELLE RAFFAELLA (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:RAFFAELLA
Last Name:LAZZARA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12455 BROADWELL RD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6315
Mailing Address - Country:US
Mailing Address - Phone:770-375-6197
Mailing Address - Fax:706-253-3223
Practice Address - Street 1:12455 BROADWELL RD STE 102-103
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-6315
Practice Address - Country:US
Practice Address - Phone:770-375-6197
Practice Address - Fax:770-215-7577
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87864207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology