Healthcare Provider Details

I. General information

NPI: 1245435429
Provider Name (Legal Business Name): LAWRENCE LEE ROBINSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80A INTERSTATE SOUTH DR
JASPER GA
30143-6226
US

IV. Provider business mailing address

215 RIVERSTONE DR
CANTON GA
30114-5256
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-6600
  • Fax: 770-345-6611
Mailing address:
  • Phone: 770-345-6600
  • Fax: 770-345-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number066629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: