Lavonia Physician Services, LLC

NPI #1992174692 in Lavonia, Georgia

Provider Information

NPI Number: 1992174692
Entity Type: Organization
Organization Name: Lavonia Physician Services, LLC
Primary Specialty: Hospitalist
Enumeration Date: Sep 23, 2015
Last Updated: Sep 23, 2015

Practice Location

Address: 367 CLEAR CREEK PKWY
City: Lavonia
State: Georgia
ZIP Code: 30553-4173
Phone: (800) 893-9698

Authorized Official

Name: RYAN DOMENGEAUX
Title: GENERAL COUNCIL
Phone: (800) 893-9698

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Hospitalist	208M00000X	Primary

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