Provider Demographics
NPI:1144257304
Name:LAWRENCE, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 SIDNEY LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-7646
Mailing Address - Country:US
Mailing Address - Phone:856-275-7507
Mailing Address - Fax:856-299-1688
Practice Address - Street 1:CARNEY'S POINT FAMILY PRACTICE CENTER
Practice Address - Street 2:341 SHELL ROAD
Practice Address - City:CARNEY'S POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069
Practice Address - Country:US
Practice Address - Phone:856-299-4600
Practice Address - Fax:856-299-1688
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07830700207Q00000X
DEC1-0007495207Q00000X
GA87676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA87676OtherSTATE LICENSE
DE019507C29Medicare PIN
NJ110780MJPMedicare PIN