Provider Demographics
NPI:1891782918
Name:BIRCOLL, LAWRENCE A (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:BIRCOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 WINN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1735
Mailing Address - Country:US
Mailing Address - Phone:770-491-3003
Mailing Address - Fax:770-491-0729
Practice Address - Street 1:487 WINN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1735
Practice Address - Country:US
Practice Address - Phone:770-491-3003
Practice Address - Fax:770-491-0729
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036926207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000553902GMedicaid
GA000553902EMedicaid
GA000553902FMedicaid
GA000553902GMedicaid
GA20NCCPDMedicare PIN