Provider Demographics
NPI:1801823109
Name:LAWRENCE, BETHANY J (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:294 SUMMAR DR
Mailing Address - Street 2:DEPT 289
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3915
Mailing Address - Country:US
Mailing Address - Phone:731-265-8220
Mailing Address - Fax:731-265-8355
Practice Address - Street 1:294 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3915
Practice Address - Country:US
Practice Address - Phone:731-423-1932
Practice Address - Fax:731-423-4919
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN38605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
626001636OtherHEALTH PARTNERS
626001636OtherUSA MANAGED CARE
TN1445202OtherCIGNA
TN186392OtherUNISON
626001636OtherUNITED HEALTHCARE
TN3897530Medicaid
TN31851OtherTLC
TN4122467OtherBLUE CROSS BLUE SHIELD
TN31851OtherTLC
626001636OtherUSA MANAGED CARE