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General NPI Number Information
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NPI Number | 1902341878
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Entity Type | Individual
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Provider Name | LAWRENCE WILLIAMS CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 21298 OLEAN BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6705
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Country | US
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Telephone | 404-754-5059
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 956162
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City | DULUTH
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State | GA
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Zip | 30095-9503
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Country | US
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Telephone | 404-754-5059
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN9446981
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License Number State | FL
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