Provider Demographics
NPI:1013377092
Name:LAWSON, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5204
Mailing Address - Country:US
Mailing Address - Phone:865-647-1876
Mailing Address - Fax:865-471-2246
Practice Address - Street 1:120 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5204
Practice Address - Country:US
Practice Address - Phone:865-647-1876
Practice Address - Fax:865-471-2246
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7907363A00000X
TNPA2977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant