Healthcare Provider Details

I. General information

NPI: 1982541660
Provider Name (Legal Business Name): KENTRELL RAYMOND LAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPENRYN DR
MADISON AL
35758-1890
US

IV. Provider business mailing address

3337 LITTLE ZION RD
SNEADS FL
32460-3704
US

V. Phone/Fax

Practice location:
  • Phone: 256-783-5151
  • Fax:
Mailing address:
  • Phone: 256-772-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberL226411774000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: