Provider Demographics
NPI:1689724809
Name:STARR'S MILL INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:STARR'S MILL INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-631-2502
Mailing Address - Street 1:1330 HIGHWAY 74
Mailing Address - Street 2:MAY HOUSE
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2950
Mailing Address - Country:US
Mailing Address - Phone:770-631-2502
Mailing Address - Fax:770-631-2503
Practice Address - Street 1:1330 HIGHWAY 74
Practice Address - Street 2:MAY HOUSE
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-2950
Practice Address - Country:US
Practice Address - Phone:770-631-2502
Practice Address - Fax:770-631-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC7883OtherRAILROAD MEDICARE GRP #
GA11D0983347OtherCLIA #
GAGRP7039Medicare ID - Type UnspecifiedMEDICARE GROUP #