Provider Demographics
NPI:1417672841
Name:CARSON, LAWANNA S
Entity Type:Individual
Prefix:
First Name:LAWANNA
Middle Name:S
Last Name:CARSON
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 1:1000 N PINE ST STE 18
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3182
Mailing Address - Country:US
Mailing Address - Phone:864-216-8198
Mailing Address - Fax:
Practice Address - Street 1:1000 N PINE ST STE 18
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3182
Practice Address - Country:US
Practice Address - Phone:864-216-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCK4G3X2F6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy