Provider Demographics
NPI:1164721924
Name:WEED, LAWRENCE HUGHES
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HUGHES
Last Name:WEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:354 SULLIVAN CIRCLE
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-0321
Mailing Address - Country:US
Mailing Address - Phone:706-573-0405
Mailing Address - Fax:
Practice Address - Street 1:6950 BEAVER RUN RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-3714
Practice Address - Country:US
Practice Address - Phone:706-563-9967
Practice Address - Fax:706-563-2789
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH009687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist