Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 1-126442 | AL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 1-126442 | AL |
NPI | 1194254490 |
---|---|
Provider Name | Mrs. Maggie Lawrence |
First Address | Gardendale, AL 35071-4208 |
Second Address | Birmingham, AL 35233-1710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 08/06/2017 |