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General NPI Number Information
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NPI Number | 1609557800
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Entity Type | Individual
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Provider Name | JORDAN RONNIE LAWSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 126 DILLON DR.
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City | SPARTANBURG
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State | SC
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Zip | 29307-1018
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Country | US
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Telephone | 864-327-1212
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Fax | 864-327-1211
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Provider Business Mailing Address
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Address Line | 126 DILLON DR.
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City | SPARTANBURG
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State | SC
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Zip | 29307-1018
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Country | US
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Telephone | 864-327-1212
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Fax | 864-327-1211
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5099
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 5300PA
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License Number State | SC
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