Provider Demographics
NPI:1780898205
Name:LAWRENCE, GLENN BOYKIN JR (CSA)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:BOYKIN
Last Name:LAWRENCE
Suffix:JR
Gender:M
Credentials:CSA
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Mailing Address - Street 1:104 E LAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1516
Mailing Address - Country:US
Mailing Address - Phone:901-853-7462
Mailing Address - Fax:
Practice Address - Street 1:104 E LAWNWOOD DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1516
Practice Address - Country:US
Practice Address - Phone:901-853-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist