Provider Demographics
NPI:1386507010
Name:ATKINSON, PHILLIP LAWRENCE
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:LAWRENCE
Last Name:ATKINSON
Suffix:
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 1:329 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3610
Mailing Address - Country:US
Mailing Address - Phone:440-714-7868
Mailing Address - Fax:
Practice Address - Street 1:1939 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3959
Practice Address - Country:US
Practice Address - Phone:440-963-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.007029175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist