1144257304 NPI number — JOHN R LAWRENCE MD

Table of content: JOHN R LAWRENCE MD (NPI 1144257304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144257304 NPI number — JOHN R LAWRENCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144257304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SIDNEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30215-7646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-275-7507
Provider Business Mailing Address Fax Number:
856-299-1688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARNEY'S POINT FAMILY PRACTICE CENTER
Provider Second Line Business Practice Location Address:
341 SHELL ROAD
Provider Business Practice Location Address City Name:
CARNEY'S POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-299-4600
Provider Business Practice Location Address Fax Number:
856-299-1688
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA07830700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C1-0007495 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 87676 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87676 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".