Individual provider Active NPI

Michael Gregory Lassiter, SURGICAL ASSISTANT

  • Surgical Physician Assistant
  • Atlanta, GA
National Provider Identifier
1396953873
Registry record updated Nov 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2795 Issued in VA
Practice address
3577 Chamblee Tucker Rd # 161a
Atlanta, GA 30341-4422
Phone
(404) 432-8746
NPI assigned
May 18, 2007
Last updated
Nov 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2795 VA Primary
Surgical Assistant 246ZC0007X 2795 VA

Addresses

Primary practice location

3577 Chamblee Tucker Rd # 161a
Atlanta, GA 30341-4422

Mailing address

3577A Chamblee Tucker Rd #161
Atlanta, GA 30341-1459
Phone (404) 432-8746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2795VAMDSurgical Assistant

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1396953873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3577A CHAMBLEE TUCKER RD #161",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411459",
            "telephone_number": "404-432-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3577 CHAMBLEE TUCKER RD # 161A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414422",
            "telephone_number": "404-432-8746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASSITER",
        "first_name": "MICHAEL",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "credential": "SURGICAL ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "2795",
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "VA",
            "license": "2795",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.