Provider Demographics
NPI:1467437913
Name:KULISH, LAWRENCE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:F
Last Name:KULISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:663 GOLD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-3181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 LUMPKIN CAMPGROUND RD N
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6206
Practice Address - Country:US
Practice Address - Phone:706-216-6446
Practice Address - Fax:706-216-6457
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine