Provider Demographics
NPI:1023904372
Name:MCCOY, LAWRENCE JEROME JR
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JEROME
Last Name:MCCOY
Suffix:JR
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 1:2311 EMERALD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2633
Mailing Address - Country:US
Mailing Address - Phone:678-891-7508
Mailing Address - Fax:
Practice Address - Street 1:2311 EMERALD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2633
Practice Address - Country:US
Practice Address - Phone:678-891-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049154119343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)