Healthcare Provider Details

I. General information

NPI: 1851744163
Provider Name (Legal Business Name): NICKI E LAWSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NICKI E. RELAN

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-2869
  • Fax: 601-815-9356
Mailing address:
  • Phone: 601-984-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT-6070
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT-6070
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: