# LAWRENCE JOEL ARMY HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265516470
- **Authorized official:** MRS. CARMEN RAKESTRAW AGNEW RPH (STAFF PHARMACIST)
- **Authorized official phone:** (404) 464-0304

## Contact information

- **Practice address:** 1701 HARDEE AVE, FT MCPHERSON, GA 30330
- **Practice address phone:** (404) 464-0304
- **Practice address fax:** (404) 464-0303
- **Mailing address:** 2156 SPINK ST NW, ATLANTA, GA 30318-1154
- **Mailing address phone:** (404) 792-5919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1102X | Military Outpatient Operational (Transportable) Component Clinic/Center | 11620 | GA | Yes |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 08/22/2020