Healthcare Provider Details

I. General information

NPI: 1093883878
Provider Name (Legal Business Name): LAVON THURMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 MCCRARY RD
FORTSON GA
31808-4558
US

IV. Provider business mailing address

1600 FORT BENNING RD
COLUMBUS GA
31903-2834
US

V. Phone/Fax

Practice location:
  • Phone: 706-987-8216
  • Fax: 706-987-8220
Mailing address:
  • Phone: 706-322-9599
  • Fax: 706-322-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019791
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: