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General NPI Number Information
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NPI Number | 1306922315
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Entity Type | Individual
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Provider Name | EDWARD C LAUTERBACH MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 940 HWY 96
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City | WARNER ROBINS
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State | GA
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Zip | 31088
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Country | US
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Telephone | 478-988-1222
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Fax | 478-988-1106
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Provider Business Mailing Address
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Address Line | 1550 COLLEGE STREET
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City | MACON
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State | GA
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Zip | 31207-1554
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Country | US
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Telephone | 478-301-4111
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Fax | 478-301-2387
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 031056
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License Number State | GA
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