Organization
LAWRENCE WILLIAM COSTA, JR.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VONNA K LAYNE (OFFICE MANAGER)
(931) 924-4200
Entity
Organization
Contact information
Practice address
1410 UNIVERSITY AVE, SEWANEE, TN 37375-2304
(931) 924-4200
Mailing address
PO BOX 9, MONTEAGLE, TN 37356-0009
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/26/2008
Last updated
03/26/2008
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