Provider Demographics
NPI:1275719775
Name:LAWRENCE, PHILIP M (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2304
Mailing Address - Country:US
Mailing Address - Phone:706-886-8800
Mailing Address - Fax:706-886-8800
Practice Address - Street 1:334 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2304
Practice Address - Country:US
Practice Address - Phone:706-886-8800
Practice Address - Fax:706-886-8800
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001552111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography