Provider Demographics
NPI:1386693620
Name:LAWHORNE, THOMAS WALTER JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:LAWHORNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8805
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8805
Mailing Address - Country:US
Mailing Address - Phone:706-596-8200
Mailing Address - Fax:706-571-0207
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 1009
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-596-8200
Practice Address - Fax:706-571-0207
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020333208G00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000193135IMedicaid
GA202I332813OtherMEDICARE PTAN
GA000193135FMedicaid
GAD40413Medicare UPIN
GA202I337501Medicare UPIN