Provider Demographics
NPI:1053317925
Name:LAWRENCE, HARRY M (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1042 E 3RD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2167
Mailing Address - Country:US
Mailing Address - Phone:423-265-1651
Mailing Address - Fax:423-756-0050
Practice Address - Street 1:1042 E 3RD ST
Practice Address - Street 2:STE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2167
Practice Address - Country:US
Practice Address - Phone:423-265-1651
Practice Address - Fax:423-756-0050
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-01-19
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Provider Licenses
StateLicense IDTaxonomies
TNMD 2936207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00061894AOtherGA MEDICAID
TN3144956Medicaid
TN3144956Medicaid
B02097Medicare UPIN