Healthcare Provider Details

I. General information

NPI: 1922093350
Provider Name (Legal Business Name): RAYMOND A LAWHEAD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD STE# 408
DECATUR GA
30033-6131
US

IV. Provider business mailing address

2675 N DECATUR RD STE# 408
DECATUR GA
30033-6131
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-7100
  • Fax: 404-501-7105
Mailing address:
  • Phone: 404-501-7100
  • Fax: 404-501-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number027853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: