Provider Demographics
NPI:1033878913
Name:GILL, LAWRENCE JR
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:GILL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4770 THE ARBORS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-3921
Mailing Address - Country:US
Mailing Address - Phone:980-358-4484
Mailing Address - Fax:
Practice Address - Street 1:4770 THE ARBORS DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-3921
Practice Address - Country:US
Practice Address - Phone:980-358-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WV0202X
NC347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No171WV0202XOther Service ProvidersContractorVehicle Modifications