Healthcare Provider Details

I. General information

NPI: 1669575064
Provider Name (Legal Business Name): JOSEPH KEITH LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5310
US

IV. Provider business mailing address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5310
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2046
  • Fax: 901-946-9262
Mailing address:
  • Phone: 901-261-2046
  • Fax: 901-946-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD0000016111
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: