Provider Demographics
NPI:1790721694
Name:MARABLE, LAWRENCE E (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:MARABLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 EISENHOWER PKWY
Mailing Address - Street 2:SUITE # 268
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3649
Mailing Address - Country:US
Mailing Address - Phone:478-474-8037
Mailing Address - Fax:478-474-8367
Practice Address - Street 1:3661 EISENHOWER PKWY
Practice Address - Street 2:SUITE # 268
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3649
Practice Address - Country:US
Practice Address - Phone:478-474-8037
Practice Address - Fax:478-474-8367
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00302772BMedicaid
GA00302772CMedicaid