Provider Demographics
NPI:1962413104
Name:LAWRENCE, ERNEST CLINTON (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:CLINTON
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 SHADOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1267
Mailing Address - Country:US
Mailing Address - Phone:404-502-6262
Mailing Address - Fax:
Practice Address - Street 1:4320 SHADOW OAK LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-1267
Practice Address - Country:US
Practice Address - Phone:404-502-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036556207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE07183Medicare UPIN