Basic Information
| Provider Information | |||||||||
| NPI: | 1487699617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN LAWSON SURGICAL GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 PROFESSIONAL PARK DRIVE | ||||||||
| Address2: | SUITE 31 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755650 | ||||||||
| FaxNumber: | 4239755652 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 PROFESSIONAL PARK DR STE 31 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755650 | ||||||||
| FaxNumber: | 4239755652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4239755650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3388129 | 05 | TN | MEDICAID |