Individual
DR. JASON LAMAR LAIRSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
103 W CRANFORD AVE, VALDOSTA, GA 31602-2930
(229) 249-0717
Mailing address
3796 CREEKWOOD DR, VALDOSTA, GA 31602-0857
(229) 244-7882
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012916
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
369182184A
—
GA
Enumeration date
12/11/2006
Last updated
07/08/2007
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