Doctor Name: | MRS. MARILYN LAWRENCE |
NPI Number: | 1952328528 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | PT001612 |
Business Practice Address: | 7950 Martin Loop Building 9200 Fort Benning, GA - 319055647 |
Business Phone Number: | 7065442041 |
Business Fax Number: | |
Mailing Address: | 4157 Windtree Ln, COLUMBUS |
State: | GA |
Postal Code: | 319071817 |
Phone Number: | 7065686043 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | PT001612 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |