Provider Demographics
NPI:1326524687
Name:LAWSON, STEPHANIE WOLFRUM (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WOLFRUM
Last Name:LAWSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 BATTLEFIELD PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4036
Mailing Address - Country:US
Mailing Address - Phone:423-827-5287
Mailing Address - Fax:
Practice Address - Street 1:2636 BATTLEFIELD PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4036
Practice Address - Country:US
Practice Address - Phone:423-827-5287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily