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General NPI Number Information
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NPI Number | 1285750166
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Entity Type | Individual
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Provider Name | TROY MICHAEL LAWHORN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 4451 COUNTRY CLUB RD SUITE B
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City | STATESBORO
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State | GA
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Zip | 30458-9233
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Country | US
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Telephone | 912-764-4495
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1985
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City | STATESBORO
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State | GA
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Zip | 30459-1985
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Country | US
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Telephone | 912-764-4495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012756
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4292
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN012756
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License Number State | GA
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