Basic Information
Provider Information
NPI: 1548232036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOCHILAS
FirstName: LAZAROS
MiddleName: K
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2835 BRANDYWINE RD
Address2: SUITE 300
City: ATLANTA
State: GA
PostalCode: 303415510
CountryCode: US
TelephoneNumber: 4042562593
FaxNumber: 7704889408
Practice Location
Address1: 5461 MERIDIAN MARK RD STE 530
Address2:  
City: ATLANTA
State: GA
PostalCode: 303423283
CountryCode: US
TelephoneNumber: 4042562593
FaxNumber: 7704889408
Other Information
ProviderEnumerationDate: 02/07/2006
LastUpdateDate: 01/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202XMD11036RIN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
2080P0202X216383MAN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
2080P0202X073331GAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

ID Information
IDTypeStateIssuerDescription
701030205RI MEDICAID


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