Individual
LAWRENCE CRAIG ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
21O E MAIN ST., CANDOR, NC 27229-8088
(910) 974-7555
(910) 974-4555
Mailing address
PO BOX 843145, BOSTON, MA 02284-3145
(910) 974-7555
(910) 974-4555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
101376
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970018704
R R MEDICARE
NC
01
—
D0491
MEDCOST
NC
01
—
FH4000420
FIRST CAROLINA CARE
NC
Enumeration date
06/28/2006
Last updated
05/20/2013
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