Basic Information
Provider Information | |||||||||
NPI: | 1215901277 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAWHORN GAY | ||||||||
FirstName: | TERESA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1707 | ||||||||
Address2: |   | ||||||||
City: | MILLEDGEVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 310591707 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4784572036 | ||||||||
FaxNumber: | 4784572042 | ||||||||
Practice Location | |||||||||
Address1: | 821 N COBB ST | ||||||||
Address2: |   | ||||||||
City: | MILLEDGEVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 310612343 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4784572036 | ||||||||
FaxNumber: | 4784572042 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/15/2006 | ||||||||
LastUpdateDate: | 10/12/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN096610 | GA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 00547093B | 05 | GA |   | MEDICAID | 430076995 | 01 | GA | MCRB RAILROAD | OTHER |