1871244046 NPI number — MR. GERALD JEROME LAWRENCE JR. CIT

Table of content: MR. GERALD JEROME LAWRENCE JR. CIT (NPI 1871244046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871244046 NPI number — MR. GERALD JEROME LAWRENCE JR. CIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
GERALD
Provider Middle Name:
JEROME
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
CIT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE
Provider Other First Name:
GERALD
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
CIT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871244046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 NORTHWOODS PLZ, MACON, GA 31204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31204-5361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-330-7164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 NORTHWOODS PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-330-7164
Provider Business Practice Location Address Fax Number:
478-330-7167
Provider Enumeration Date:
01/10/2022

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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