Provider Demographics
NPI:1487337655
Name:JOHNSON, LAWRENCE H SR (CDL)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:CDL
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 40131
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-0131
Mailing Address - Country:US
Mailing Address - Phone:225-485-2121
Mailing Address - Fax:
Practice Address - Street 1:479 WOODCLIFF DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6659
Practice Address - Country:US
Practice Address - Phone:225-485-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007472544343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)