Provider Demographics
NPI:1679889737
Name:LAWTON, ERIC GERARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GERARD
Last Name:LAWTON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:#101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1716
Mailing Address - Country:US
Mailing Address - Phone:404-758-0770
Mailing Address - Fax:404-581-5292
Practice Address - Street 1:1188 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:#101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1716
Practice Address - Country:US
Practice Address - Phone:404-758-0770
Practice Address - Fax:404-581-5292
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111376CMedicaid