Provider Demographics
NPI:1497868897
Name:SCHWARTZ, LAURENCE WILLIAMSON (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:WILLIAMSON
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E REELFOOT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5871
Mailing Address - Country:US
Mailing Address - Phone:731-599-9766
Mailing Address - Fax:731-599-9887
Practice Address - Street 1:6025 WALNUT GROVE RD STE 207
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2122
Practice Address - Country:US
Practice Address - Phone:901-226-0200
Practice Address - Fax:901-226-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1368207X00000X, 207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT08583AOtherMEDICARE
TN6186186OtherBCBS
TN1515921Medicaid
TN33064911Medicaid
TN3306499Medicaid
TN4158378OtherBCBS
TN33064911Medicare PIN
TN4158378OtherBCBS
TN4036965OtherBLUE CROSS BLUE SHIELD