Basic Information
| Provider Information | |||||||||
| NPI: | 1275508962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUNTS | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | DWAYNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1216 | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386141216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626244292 | ||||||||
| FaxNumber: | 6626244354 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 DAVID RAINES RD | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711075899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184252252 | ||||||||
| FaxNumber: | 3184252367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | E3271 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 20851 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 203460 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 148220001 | 05 | AR | MEDICAID |