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General NPI Number Information
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NPI Number | 1427087592
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Entity Type | Individual
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Provider Name | LAWRENCE L LINE JR. M.D.,
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Gender | Male
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 3688 VETERANS MEMORIAL DR SUITE 200
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City | HATTIESBURG
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State | MS
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Zip | 39401-8246
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Country | US
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Telephone | 601-554-7400
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Fax | 601-554-7488
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Provider Business Mailing Address
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Address Line | 3688 VETERANS MEMORIAL DR SUITE 200
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City | HATTIESBURG
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State | MS
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Zip | 39401-8246
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Country | US
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Telephone | 601-554-7400
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Fax | 601-554-7488
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 12369
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License Number State | MS
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