Provider Demographics
NPI:1063276350
Name:BELTON, LORENZO JAMES
Entity type:Individual
Prefix:PROF
First Name:LORENZO
Middle Name:JAMES
Last Name:BELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 JOHN EDDYE RD
Mailing Address - Street 2:
Mailing Address - City:CASSATT
Mailing Address - State:SC
Mailing Address - Zip Code:29032-9460
Mailing Address - Country:US
Mailing Address - Phone:803-420-2061
Mailing Address - Fax:
Practice Address - Street 1:963 JOHN EDDYE RD
Practice Address - Street 2:
Practice Address - City:CASSATT
Practice Address - State:SC
Practice Address - Zip Code:29032-9460
Practice Address - Country:US
Practice Address - Phone:803-420-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)