Provider Demographics
NPI:1336461524
Name:HEAVRIN, LAWRENCE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:HEAVRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:123 SHOREHAM RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-3822
Mailing Address - Country:US
Mailing Address - Phone:864-579-3691
Mailing Address - Fax:864-579-3691
Practice Address - Street 1:123 SHOREHAM RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-3822
Practice Address - Country:US
Practice Address - Phone:864-579-3691
Practice Address - Fax:864-579-3691
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine