Basic Information
| Provider Information | |||||||||
| NPI: | 1033660386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN LAWSON SURGICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE 31 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE 31 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2016 | ||||||||
| LastUpdateDate: | 10/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | CUTSHALL | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 4239755650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 21566 | TN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.