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General NPI Number Information
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NPI Number | 1871798447
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Entity Type | Individual
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Provider Name | LAWRENCE BENJAMIN MCEACHIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3827 GRANDVIEW AVE
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City | MERIDIAN
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State | MS
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Zip | 39305
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Country | US
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Telephone | 601-485-9875
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5203
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City | MERIDIAN
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State | MS
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Zip | 39302
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Country | US
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Telephone | 601-485-9875
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 05464
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License Number State | MS
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