Provider Demographics
NPI:1902018716
Name:SUTTON, LAWRENCE MADISON II (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MADISON
Last Name:SUTTON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:MADISON
Other - Last Name:SUTTON
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0588
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:
Practice Address - Street 1:1668 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-5332
Practice Address - Country:US
Practice Address - Phone:601-859-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1114851Medicaid
MS1083778617OtherNPI NUMBER