Healthcare Provider Details

I. General information

NPI: 1174584783
Provider Name (Legal Business Name): SHAWN THOMAS LAWSON LAWSON IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D MEDICAL BATTALION
CAMP LEJEUNE NC
28542
US

IV. Provider business mailing address

108 ENGLAND LN
RICHLANDS NC
28574-7152
US

V. Phone/Fax

Practice location:
  • Phone: 910-382-9464
  • Fax:
Mailing address:
  • Phone: 910-382-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: