Provider Demographics
NPI:1598981813
Name:LAWRENCE, KARLTON LAMAR (MSR-PT)
Entity Type:Individual
Prefix:MR
First Name:KARLTON
Middle Name:LAMAR
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MSR-PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7658 FOREST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122
Mailing Address - Country:US
Mailing Address - Phone:770-944-6155
Mailing Address - Fax:
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:B1 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-587-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist