Provider Demographics
NPI:1427480722
Name:BUTLER, LAWRENCE BENTON JR (ATC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:BENTON
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WORCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6650
Mailing Address - Country:US
Mailing Address - Phone:864-228-7056
Mailing Address - Fax:
Practice Address - Street 1:513 WORCHESTER PL
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6650
Practice Address - Country:US
Practice Address - Phone:864-228-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty