Provider Demographics
NPI:1174534697
Name:LAWRENCE, JULIA ANN (DO)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DO
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 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25245207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131849Medicaid
808462OtherPARTNERS
192387OtherMEDCOST
VA1174534697Medicaid
143T8OtherBCBS
7592181OtherAETNA
NC5905973Medicaid
WV3810007277Medicaid
SCQ0157FMedicaid
LA1131849Medicaid
143T8OtherBCBS
808462OtherPARTNERS
NC5905973Medicaid