Provider Demographics
NPI:1427739754
Name:LAWRENCE, GREGORY MARKELL JR
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARKELL
Last Name:LAWRENCE
Suffix:JR
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 1:2300 MONTANA AVE STE 419
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3829
Mailing Address - Country:US
Mailing Address - Phone:513-407-9078
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE STE 419
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-407-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide