Provider Demographics
NPI:1952487951
Name:LAWRENCE, WILLIAM H (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4188
Mailing Address - Country:US
Mailing Address - Phone:770-337-7975
Mailing Address - Fax:
Practice Address - Street 1:1629 SANDPIPER CT
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4188
Practice Address - Country:US
Practice Address - Phone:770-337-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR 006090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00890238AMedicaid
GAU72148Medicare UPIN
GA35ZCFJCMedicare ID - Type UnspecifiedMEDICARE