Provider Demographics
NPI:1063817328
Name:DEARDURFF, LAWRENCE ROBERT III (PA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:DEARDURFF
Suffix:III
Gender:M
Credentials:PA
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Mailing Address - Street 1:677 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1101
Mailing Address - Country:US
Mailing Address - Phone:770-793-7750
Mailing Address - Fax:470-986-7142
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-793-7750
Practice Address - Fax:470-986-7142
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2023-09-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant