Provider Demographics
NPI:1285750166
Name:LAWHORN, TROY MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:MICHAEL
Last Name:LAWHORN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1985
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1985
Mailing Address - Country:US
Mailing Address - Phone:912-764-4495
Mailing Address - Fax:
Practice Address - Street 1:4451 COUNTRY CLUB RD
Practice Address - Street 2:SUITE B
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-9233
Practice Address - Country:US
Practice Address - Phone:912-764-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012756122300000X, 1223S0112X
SC42921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist