Basic Information
| Provider Information | |||||||||
| NPI: | 1679794911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAVELINA | ||||||||
| FirstName: | LYUBOV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ZAVELINA | ||||||||
| OtherFirstName: | LYUBOV | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 91 MORELAND AVE SE | ||||||||
| Address2: | UNIT A | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303161336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042732490 | ||||||||
| FaxNumber: | 4786335384 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 HEMLOCK STREET | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336706 | ||||||||
| FaxNumber: | 4786335384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN150738 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 691829631A | 01 | GA | PEACHSTATE CMO - MCCG | OTHER | P00333451 | 01 | GA | RAILROAD MCR - MCCG | OTHER | 344411 | 01 | GA | WELLCARE CMO - MCCG | OTHER | 691829631A | 05 | GA | MEDICAID |