Provider Demographics
NPI:1598878621
Name:LAWRENCE F. KULISH PC
Entity type:Organization
Organization Name:LAWRENCE F. KULISH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KULISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-216-6446
Mailing Address - Street 1:35 LUMPKIN CAMPGROUND RD N
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6206
Mailing Address - Country:US
Mailing Address - Phone:706-216-6446
Mailing Address - Fax:706-216-6457
Practice Address - Street 1:35 LUMPKIN CAMPGROUND RD N
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6206
Practice Address - Country:US
Practice Address - Phone:706-216-6446
Practice Address - Fax:706-216-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty