Provider Demographics
NPI:1407867344
Name:BRANT, LAWRENCE RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAYMOND
Last Name:BRANT
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 1:1809 HARDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1164
Mailing Address - Country:US
Mailing Address - Phone:478-738-0033
Mailing Address - Fax:478-738-0233
Practice Address - Street 1:1809 HARDEMAN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1164
Practice Address - Country:US
Practice Address - Phone:478-738-0033
Practice Address - Fax:478-738-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor