Healthcare Provider Details

I. General information

NPI: 1558347450
Provider Name (Legal Business Name): DAVID W LAWHORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DRIVE NORTHCREST MEDICAL CENTER, ED DEPARTMENT
SPRINGFIELD TN
37172
US

IV. Provider business mailing address

PO BOX 305172 DEPT 109
NASHVILLE TN
37230-5172
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-5034
  • Fax: 931-552-6663
Mailing address:
  • Phone: 931-647-5034
  • Fax: 931-552-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number19204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: