Provider Demographics
NPI:1609622950
Name:LAWRENCE,, TACARRO (PBT)
Entity type:Individual
Prefix:
First Name:TACARRO
Middle Name:
Last Name:LAWRENCE,
Suffix:
Gender:F
Credentials:PBT
Other - Prefix:
Other - First Name:PHLEBOTOMY LABS2GO
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:421 WHITEHALL STREET
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-1471
Mailing Address - Country:US
Mailing Address - Phone:770-966-3662
Mailing Address - Fax:
Practice Address - Street 1:421 WHITEHALL ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1471
Practice Address - Country:US
Practice Address - Phone:770-966-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy