Provider Demographics
NPI:1689371809
Name:COX, LAWRENCE
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 RIVERGREEN BND SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-8546
Mailing Address - Country:US
Mailing Address - Phone:312-505-1435
Mailing Address - Fax:
Practice Address - Street 1:1618 RIVERGREEN BND SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-8546
Practice Address - Country:US
Practice Address - Phone:312-505-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
178.018210OtherINSURANCE CARRIERS
IL178.018210Medicaid