Provider Demographics
NPI:1356438394
Name:LAWRENCE, RUSSELL FRANKLIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:FRANKLIN
Last Name:LAWRENCE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:141 ROSECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-2235
Mailing Address - Country:US
Mailing Address - Phone:423-348-6814
Mailing Address - Fax:
Practice Address - Street 1:VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:LAMONT AND SYDNEY STREETS
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3518
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000000175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant