Provider Demographics
NPI:1871720003
Name:LAVALLO, JOSEPH (NP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LAVALLO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2114
Mailing Address - Country:US
Mailing Address - Phone:770-706-0051
Mailing Address - Fax:
Practice Address - Street 1:1267 HIGHWAY 54 W
Practice Address - Street 2:SUITE 2200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2114
Practice Address - Country:US
Practice Address - Phone:770-706-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214862363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care