Provider Demographics
NPI:1396827457
Name:LAWRENCE, JENNIFER E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2576
Mailing Address - Country:US
Mailing Address - Phone:229-219-0247
Mailing Address - Fax:229-219-0837
Practice Address - Street 1:2418 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2576
Practice Address - Country:US
Practice Address - Phone:229-219-0247
Practice Address - Fax:229-219-0837
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044001207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00755004CMedicaid
GA00755004CMedicaid
GA44ZCBHJ01Medicare ID - Type Unspecified