Basic Information
| Provider Information | |||||||||
| NPI: | 1962446369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWSON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4715 WHITESBURG DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Practice Location | |||||||||
| Address1: | 26642 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357397624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564238744 | ||||||||
| FaxNumber: | 2562169652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 03/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-073582 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.