Lazzara Dermatology & Mohs Surgery of Milton, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

LAZZARA DERMATOLOGY & MOHS SURGERY OF MILTON, LLC

Practice address

12455 Broadwell Rd Ste 102-103
Milton, GA 30004-6315

Phone

(770) 375-6197

Fax

(770) 215-7577

NPI assigned

May 18, 2024

Last updated

Jan 28, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Danielle Raffaella Lazzara, DONPI 1912351347

Title

Chief Medical Officer

Phone

(732) 977-8371

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Danielle Raffaella Lazzara, D.O.

  • MOHS-Micrographic Surgery Physician
  • Milton, GA
  • NPI 1912351347
  Medicare reassignment NPD Authorized official
• Paige Cecilia Hyland

  • Physician Assistant
  • Milton, GA
  • NPI 1427972819
  NPD (past)

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

{
    "created_epoch": "1715990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1619726890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12455 BROADWELL RD STE 102-103",
            "city": "MILTON",
            "state": "GA",
            "postal_code": "300046315",
            "telephone_number": "770-375-6197",
            "fax_number": "770-215-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12455 BROADWELL RD STE 102-103",
            "city": "MILTON",
            "state": "GA",
            "postal_code": "300046315",
            "telephone_number": "770-375-6197",
            "fax_number": "770-215-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAZZARA DERMATOLOGY & MOHS SURGERY OF MILTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-18",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A",
        "authorized_official_last_name": "LAZZARA",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "RAFFAELLA",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "732-977-8371",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oksana Kershteyn, MD
• Dzeneta Krndzija, NP-C
• Sophia Lillian Lamarca
• Teresa Parham Lane, PMHNP
• Courtney C Larson, CRNA, FNP-C
• Danielle Raffaella Lazzara, D.O.
• Minh-Thu Le
• Jung M. Lee, D.M.D.
• Taeyoung Lee, DMD
• Lenus Louis, MD

• MOHS-Micrographic Surgery Physician in Milton, GA
• Providers in Milton, GA by specialty
• MOHS-Micrographic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.