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General NPI Number Information
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NPI Number | 1588989008
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Entity Type | Organization
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Legal Business Name | JAMESTOWN HEALTHCARE CLINIC, LLC
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 1417 N. MAIN ST
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City | JAMESTOWN
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State | KY
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Zip | 42629
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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 966
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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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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | JERRY W LAWSON
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Credential | M.D.
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Telephone | 270-343-2597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5260P
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License Number State | KY
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