Healthcare Provider Details

I. General information

NPI: 1356729701
Provider Name (Legal Business Name): KRISTIE LASHAWN LAWSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 PLUNKET RD
UNADILLA GA
31091-5600
US

IV. Provider business mailing address

23 HUMMINGBIRD RD
ABBEVILLE GA
31001-4714
US

V. Phone/Fax

Practice location:
  • Phone: 478-627-2126
  • Fax: 478-627-9427
Mailing address:
  • Phone: 229-467-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN141266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: