Healthcare Provider Details

I. General information

NPI: 1720193618
Provider Name (Legal Business Name): THOMAS LAWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE B1400
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE B1400
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3681
  • Fax: 404-778-3337
Mailing address:
  • Phone: 404-778-3681
  • Fax: 404-778-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number030812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: