Provider Demographics
NPI:1093883878
Name:THURMAN, LAVON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVON
Middle Name:
Last Name:THURMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FORT BENNING RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2834
Mailing Address - Country:US
Mailing Address - Phone:706-322-9599
Mailing Address - Fax:706-322-9567
Practice Address - Street 1:94 MCCRARY RD
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-4558
Practice Address - Country:US
Practice Address - Phone:706-987-8216
Practice Address - Fax:706-987-8220
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000225607IMedicaid
GAE57095Medicare UPIN