Provider Demographics
NPI:1306555982
Name:LAWLER-MARTIN, ANITA CAROL (BSN RN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:CAROL
Last Name:LAWLER-MARTIN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 N DEARING ST SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2621
Mailing Address - Country:US
Mailing Address - Phone:770-355-6952
Mailing Address - Fax:
Practice Address - Street 1:867 COMMERCE DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6604
Practice Address - Country:US
Practice Address - Phone:770-679-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123383163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse