Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Lawrence Robert Deardurff III, PA

Individual provider Physician Assistant · NPI 1063817328

Mr. Lawrence Robert Deardurff III, PA is a Physician Assistant in Marietta, Georgia. Qualified in 2014, 12 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
12
In the registry since
2014
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

677 Church St NE
Marietta, GA 30060-1101
Phone: (770) 793-7750
Fax: (470) 986-7142
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5665 New Northside Dr, Atlanta, GA 30328-5831 — (678) 946-1431

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1063817328
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedOctober 29, 2014
Last updated in NPPESSeptember 6, 2023
Certification dateSeptember 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Marietta