Provider Demographics
NPI:1477501138
Name:MADLOCK, LAWRENCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:E
Last Name:MADLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE STE 922
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3483
Mailing Address - Country:US
Mailing Address - Phone:901-448-5630
Mailing Address - Fax:901-448-7255
Practice Address - Street 1:910 MADISON AVE STE 922
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3483
Practice Address - Country:US
Practice Address - Phone:901-448-5630
Practice Address - Fax:901-448-7255
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10777207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3876951Medicaid
TN3876951Medicaid
TN3876951Medicaid