Provider Demographics
NPI:1679794911
Name:ZAVELINA, LYUBOV (CRNA)
Entity type:Individual
Prefix:MS
First Name:LYUBOV
Middle Name:
Last Name:ZAVELINA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYUBOV
Other - Middle Name:
Other - Last Name:ZAVELINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:91 MORELAND AVE SE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1336
Mailing Address - Country:US
Mailing Address - Phone:404-273-2490
Mailing Address - Fax:478-633-5384
Practice Address - Street 1:777 HEMLOCK STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-633-6706
Practice Address - Fax:478-633-5384
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN150738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA691829631AOtherPEACHSTATE CMO - MCCG
GAP00333451OtherRAILROAD MCR - MCCG
GA344411OtherWELLCARE CMO - MCCG
GA691829631AMedicaid
GA43BBCDFMedicare ID - Type UnspecifiedMCCG
GAQ66883Medicare UPIN