MEDICARE: LAWRENCE G. SHORY MD

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	2083A0100X	Aerospace Medicine Physician	14751	AL

General Provider Information

NPI Number	:	1386617280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE G. SHORY MD

Provider Business Mailing Address
First Line	:	77 SWEETGUM RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-5034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 E LAKE BLVD
Second Line	:	117MDG
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3545
Country	:	US
Telephone Number	:	205-714-2213
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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