Provider Demographics
NPI:1639865546
Name:LAWRENCE A UKPONG MD PC
Entity Type:Organization
Organization Name:LAWRENCE A UKPONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:UKPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-891-9087
Mailing Address - Street 1:1 SWEET BAY CT
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6756
Mailing Address - Country:US
Mailing Address - Phone:229-891-9087
Mailing Address - Fax:
Practice Address - Street 1:1 SWEET BAY CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6756
Practice Address - Country:US
Practice Address - Phone:229-891-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty