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General NPI Number Information
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NPI Number | 1326046913
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Entity Type | Individual
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Provider Name | JERRY WAYNE LAWSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 1417 N MAIN STREET
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City | JAMESTOWN
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State | KY
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Zip | 42629-0966
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Country | US
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Telephone | 270-343-2597
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Fax | 270-343-2598
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Provider Business Mailing Address
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Address Line | PO BOX 1080
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City | BURKESVILLE
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State | KY
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Zip | 42717-1080
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Country | US
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Telephone | 270-864-1472
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Fax | 270-864-1693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33028
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License Number State | KY
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