Healthcare Provider Details

I. General information

NPI: 1457045288
Provider Name (Legal Business Name): CHRISTOPHER STEVEN LAWRENCE MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 CANDLER CT
LAWRENCEVILLE GA
30046-7442
US

IV. Provider business mailing address

751 CANDLER CT
LAWRENCEVILLE GA
30046-7442
US

V. Phone/Fax

Practice location:
  • Phone: 404-268-6270
  • Fax:
Mailing address:
  • Phone: 404-268-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: