Provider Demographics
NPI:1902994023
Name:LAHATTE, LAWRENCE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAMES
Last Name:LAHATTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 N BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3096
Mailing Address - Country:US
Mailing Address - Phone:706-868-0104
Mailing Address - Fax:
Practice Address - Street 1:2258 WRIGHTSBORO RD
Practice Address - Street 2:STE. 401
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4887
Practice Address - Country:US
Practice Address - Phone:706-481-7584
Practice Address - Fax:706-481-7220
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35081207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000054464Medicaid
GAB 24200Medicare UPIN