Healthcare Provider Details

I. General information

NPI: 1689724809
Provider Name (Legal Business Name): STARR'S MILL INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 HIGHWAY 74 MAY HOUSE
FAYETTEVILLE GA
30215-2950
US

IV. Provider business mailing address

1330 HIGHWAY 74 MAY HOUSE
FAYETTEVILLE GA
30215-2950
US

V. Phone/Fax

Practice location:
  • Phone: 770-631-2502
  • Fax: 770-631-2503
Mailing address:
  • Phone: 770-631-2502
  • Fax: 770-631-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. ANTHONY F LAWSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-631-2502