Provider Demographics
NPI:1871798447
Name:MCEACHIN, LAWRENCE BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BENJAMIN
Last Name:MCEACHIN
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:PO BOX 5203
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302
Mailing Address - Country:US
Mailing Address - Phone:601-485-9875
Mailing Address - Fax:
Practice Address - Street 1:3827 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305
Practice Address - Country:US
Practice Address - Phone:601-485-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05464207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B65042Medicare UPIN