Provider Demographics
NPI:1457603938
Name:LAWRENCE, DAVID SCOTT (LMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 COLUMBIA DR
Mailing Address - Street 2:LOT 49
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-4183
Mailing Address - Country:US
Mailing Address - Phone:843-902-4863
Mailing Address - Fax:
Practice Address - Street 1:514 ALDER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3854
Practice Address - Country:US
Practice Address - Phone:843-902-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS . 8159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist