Provider Demographics
NPI:1871244046
Name:LAWRENCE, GERALD JEROME JR (CIT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JEROME
Last Name:LAWRENCE
Suffix:JR
Gender:M
Credentials:CIT
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:J
Other - Last Name:LAWRENCE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:CIT
Mailing Address - Street 1:890 NORTHWOODS PLZ, MACON, GA 31204
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-5361
Mailing Address - Country:US
Mailing Address - Phone:478-330-7164
Mailing Address - Fax:
Practice Address - Street 1:890 NORTHWOODS PLZ
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204
Practice Address - Country:US
Practice Address - Phone:478-330-7164
Practice Address - Fax:478-330-7167
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)