Basic Information
| Provider Information | |||||||||
| NPI: | 1740734490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWSON | ||||||||
| FirstName: | NEDA | ||||||||
| MiddleName: | MARIE JACKSON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAWSON | ||||||||
| OtherFirstName: | NEDA | ||||||||
| OtherMiddleName: | MARIE JACKSON | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN, FNP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2978 HIGHWAY 36 W | ||||||||
| Address2: | JACKSON | ||||||||
| City: | JACKSON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302336150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705042144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4222 FAIRBANKS DR | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305662811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705346053 | ||||||||
| FaxNumber: | 7705346695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2016 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN194562 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 003225270A | 05 | GA | MEDICAID | 003225270B | 05 | GA | MEDICAID | 08191138 | 01 | GA | AMERIGROUP | OTHER |