Provider Demographics
NPI:1790868065
Name:LAWRENCE, MALLORY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:ANDREW
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 6500
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5104
Mailing Address - Country:US
Mailing Address - Phone:706-722-2118
Mailing Address - Fax:706-722-0342
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 6500
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-722-2118
Practice Address - Fax:706-722-0342
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-02-15
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Provider Licenses
StateLicense IDTaxonomies
GA026578208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4140381OtherAETNA
SCG26578Medicaid
GA00399517AMedicaid
GA1621144003OtherCIGNA
GA2089751OtherAETNA HMO
GA1621144004OtherCIGNA HMO
GA020014961Medicare ID - Type UnspecifiedRAILROAD
GA1621144004OtherCIGNA HMO
GAE19954Medicare UPIN