Provider Demographics
NPI:1225132699
Name:LAWSON, DEIRDRE MAE CLAIREWEN (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MAE CLAIREWEN
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:235 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763
Practice Address - Country:US
Practice Address - Phone:229-759-6508
Practice Address - Fax:229-759-9950
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000608858FMedicaid
GA110087556OtherRR MCARE - EAMC
GA497274OtherBCBS - LMAC
GA5933590OtherAETNA
GA110087557OtherRR MCARE - LMAC
GA000608858AMedicaid
GA497273OtherBCBS - EAMC
GA110087556OtherRR MCARE - EAMC
GA000608858AMedicaid