MEDICARE: LAWRENCEVILLE PRIMARY CARE 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	207R00000X	Internal Medicine Physician	0101237185	VA
2	207R00000X	Internal Medicine Physician	0101044297	VA

General Provider Information

NPI Number	:	1881624682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCEVILLE PRIMARY CARE PC

Provider Business Mailing Address
First Line	:	PO BOX 459
Second Line	:
City	:	LAWRENCEVILLE
State	:	VA
Zip	:	23868-0459
Country	:	US
Telephone Number	:	434-848-0771
Fax Number	:	434-848-3415

Provider Business Practice Location Address
First Line	:	203 SHARP ST
Second Line	:
City	:	LAWRENCEVILLE
State	:	VA
Zip	:	23868
Country	:	US
Telephone Number	:	434-848-0771
Fax Number	:	434-848-3415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER J. ACKERMAN
Credential	:	MD
Telephone Number	:	434-848-0771

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/15/2007

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