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General NPI Number Information
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NPI Number | 1386617280
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Entity Type | Individual
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Provider Name | LAWRENCE G. SHORY MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5401 E LAKE BLVD 117MDG
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City | BIRMINGHAM
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State | AL
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Zip | 35217-3545
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Country | US
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Telephone | 205-714-2213
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Fax |
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Provider Business Mailing Address
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Address Line | 77 SWEETGUM RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-5034
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Country | US
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Telephone |
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 14751
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License Number State | AL
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