Provider Demographics
NPI:1801838818
Name:MCDERMOTT, LAWRENCE J III (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:MCDERMOTT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 HODGSON CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1520
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:340 HODGSON CT
Practice Address - Street 2:SUITE #2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1520
Practice Address - Country:US
Practice Address - Phone:912-629-2290
Practice Address - Fax:912-629-2291
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA069068207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300033643MMedicaid
GA003136834AMedicaid
GA003136834AMedicaid
GAGRP3039Medicare PIN