Lashaun Lee Vetzel, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

002972 Issued in GA

Practice address

3278 Mitchell Blvd
Moody AFB, GA 31699-5645

Phone

(229) 257-1459

NPI assigned

Nov 15, 2006

Last updated

Nov 15, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510704000000",
    "number": "1194898635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 RD MTG",
            "address_2": "3278 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316991500",
            "telephone_number": "229-257-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3278 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316995645",
            "telephone_number": "229-257-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VETZEL",
        "first_name": "LASHAUN",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2017-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "002972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1194898635",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD GA",
            "identifier": "667002",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970018519",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001360A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Beth Uretsky, ATC,LMT
• Jeffrey Alan Utz
• Bernard L Vanpelt, RPH
• Indra Moon Vargas, IDMT
• Michael Angelo Vernale III, PHD
• Killian Aer Viles, IDMT
• Diane-Claire Villarreal
• Kendall Vogel, DO
• Chulete Aurielle Wallace-Keane, LCSW
• Christina Marie Welch, MD

• Medical Physician Assistant in Moody AFB, GA
• Providers in Moody AFB, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.