Provider Demographics
NPI:1891334199
Name:LAWRENCE, JERRY M
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 LAWRENCE LN # 6
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23947-3611
Mailing Address - Country:US
Mailing Address - Phone:804-787-3831
Mailing Address - Fax:
Practice Address - Street 1:21 PINE RD
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947-2018
Practice Address - Country:US
Practice Address - Phone:804-787-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle