MEDICARE: DR. MARISA LAWRENCE MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	582261832	GA
2	174400000X	Specialist	38839	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582261832	OTHER	GA	TAX ID

General Provider Information

NPI Number	:	1154412401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISA LAWRENCE MD PC

Provider Business Mailing Address
First Line	:	980 JOHNSON FY RD NE STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1607
Country	:	US
Telephone Number	:	404-303-7004
Fax Number	:	404-303-7020

Provider Business Practice Location Address
First Line	:	980 JOHNSON FY RD NE STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1607
Country	:	US
Telephone Number	:	404-303-7004
Fax Number	:	404-303-7020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/20/2024

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Directions to “ DR. MARISA LAWRENCE MD PC” Practice Location

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