Provider Demographics
NPI:1851714000
Name:GREEN, LAWRIN
Entity Type:Individual
Prefix:
First Name:LAWRIN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WILLIAMSTOWN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8645
Mailing Address - Country:US
Mailing Address - Phone:803-546-0723
Mailing Address - Fax:803-807-9377
Practice Address - Street 1:810 DUTCH SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7318
Practice Address - Country:US
Practice Address - Phone:803-546-0723
Practice Address - Fax:803-807-9377
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based