Healthcare Provider Details

I. General information

NPI: 1255954244
Provider Name (Legal Business Name): AMANDA TRAKAS LAWSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5921 W FRIENDLY AVE STE D
GREENSBORO NC
27410-3268
US

IV. Provider business mailing address

1210 NEW GARDEN RD
GREENSBORO NC
27410-2721
US

V. Phone/Fax

Practice location:
  • Phone: 336-551-5830
  • Fax:
Mailing address:
  • Phone: 336-294-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013348
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number5013348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: