Provider Demographics
NPI:1043235617
Name:BLAYLOCK-LAWSON, HAZEL (PT)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:BLAYLOCK-LAWSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5337
Mailing Address - Country:US
Mailing Address - Phone:912-285-0053
Mailing Address - Fax:912-283-9289
Practice Address - Street 1:501 W ONEIDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5337
Practice Address - Country:US
Practice Address - Phone:912-283-3046
Practice Address - Fax:912-283-9289
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist