1144206053 NPI number — MR. GEORGE LAWRENCE WELCOME JR.

Table of content: MR. GEORGE LAWRENCE WELCOME JR. (NPI 1144206053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144206053 NPI number — MR. GEORGE LAWRENCE WELCOME JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCOME
Provider First Name:
GEORGE
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
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:
1144206053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6178 CORNING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32927-8861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-632-5529
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 2ND ST SW
Provider Second Line Business Practice Location Address:
SUITE 5314
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20593-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-953-2266
Provider Business Practice Location Address Fax Number:
305-953-2308
Provider Enumeration Date:
12/22/2005

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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