Provider Demographics
NPI:1972993145
Name:LAWRENCE, YOLANDA (ATC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1472
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-1472
Mailing Address - Country:US
Mailing Address - Phone:706-583-8074
Mailing Address - Fax:706-542-7707
Practice Address - Street 1:100 SMITH ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1505
Practice Address - Country:US
Practice Address - Phone:706-583-8074
Practice Address - Fax:706-542-7707
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0020662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer