Provider Demographics
NPI:1689637134
Name:ADJEI, LAWRENCE ADJETEY (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ADJETEY
Last Name:ADJEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 GOSHEN ROAD EXT STE 300
Mailing Address - Street 2:P.O. BOX 456
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5590
Mailing Address - Country:US
Mailing Address - Phone:912-826-0860
Mailing Address - Fax:855-796-7071
Practice Address - Street 1:131 GOSHEN ROAD EXT
Practice Address - Street 2:SUITE 300
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5589
Practice Address - Country:US
Practice Address - Phone:912-826-0860
Practice Address - Fax:855-796-7071
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA704507899AMedicaid
GA704507899AMedicaid
H79516Medicare UPIN