LAZZARA DERMATOLOGY & MOHS SURGERY OF MILTON, LLC
NPI 1619726890
Dermatology - MOHS-Micrographic Surgery in Milton, GA

Q: What is Lazzara Dermatology & Mohs Surgery Of Milton, LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since May 18, 2024CLIA 11D2310156 · Certificate of Compliance

12455 BROADWELL RD STE 102-103, MILTON, GA 30004(770) 375-6197(770) 215-7577 Get Directions Write a Review

NPPES record last updated: January 28, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Lazzara Dermatology & Mohs Surgery Of Milton, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAZZARA DERMATOLOGY & MOHS SURGERY OF MILTON, LLC (NPI 1619726890) is a healthcare organization registered as a mohs-micrographic surgery in Milton, Georgia and active in the NPI registry since May 2024. The organization holds a CLIA Certificate of Compliance certificate valid through April 26, 2028 and lists Danielle Raffaella Lazzara, Chief Medical Officer, as its authorized official.

NPPES Registry Identity

NPI1619726890

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameLAZZARA DERMATOLOGY & MOHS SURGERY OF MILTON, LLC

Location Address12455 BROADWELL RD STE 102-103Milton, GA 30004-6315

Mailing Address12455 Broadwell Rd Ste 102-103Milton, GA 30004-6315 · (770) 375-6197 · Fax (770) 215-7577

Phone(770) 375-6197

Fax(770) 215-7577

Organization SubpartNo

Authorized OfficialDanielle Raffaella LazzaraChief Medical Officer · (732) 977-8371

Enumeration DateMay 18, 2024

Last NPPES UpdateJanuary 28, 2025

NPPES CertifiedJanuary 28, 2025

✔ NPI 1619726890 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

12455 BROADWELL RD STE 102-103, Milton, GA 30004

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lazzara Dermatology & Mohs Surgery Of Milton, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Lazzara Dermatology & Mohs Surgery Of Milton, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Danielle Lazzara, D.O.

Dermatology

NPI 1912351347

12455 BROADWELL RD STE 102-103
Milton, GA 30004

(770) 375-6197

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 11D2310156

Lazzara Dermatology & Mohs Surgery Of Milton, LLC · Milton, GA

Active · expires Apr 26, 2028

CLIA Number11D2310156

Laboratory TypePhysician Office

Certificate Effective DateApril 27, 2026

Certificate Expiration DateApril 26, 2028

Laboratory DirectorDanielle R. Lazzara

Laboratory Phone(770) 375-6197

Laboratory LocationLazzara Dermatology & Mohs Surgery Of Milton, LLC12455 Broadwell Road, Milton, GA 30004

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lazzara Dermatology & Mohs Surgery Of Milton, LLC's NPI number?

The NPI number for Lazzara Dermatology & Mohs Surgery Of Milton, LLC is 1619726890. It was assigned to this organization in the NPPES registry on May 18, 2024.

Where is Lazzara Dermatology & Mohs Surgery Of Milton, LLC located?

Lazzara Dermatology & Mohs Surgery Of Milton, LLC is located at 12455 Broadwell Rd Ste 102-103, Milton, GA 30004. The listed phone number is (770) 375-6197.

What is Lazzara Dermatology & Mohs Surgery Of Milton, LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Lazzara Dermatology & Mohs Surgery Of Milton, LLC enrolled in Medicare?

Yes. Lazzara Dermatology & Mohs Surgery Of Milton, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lazzara Dermatology & Mohs Surgery Of Milton, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Lazzara Dermatology & Mohs Surgery Of Milton, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lazzara Dermatology & Mohs Surgery Of Milton, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 11D2310156) is associated with this NPI, valid through April 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lazzara Dermatology & Mohs Surgery Of Milton, LLC was last updated on January 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.