Provider Demographics
NPI:1578582417
Name:LAWSON, SAMUEL T (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-969-6404
Mailing Address - Fax:601-973-4541
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:STE. 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-973-4541
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS14468207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122611Medicaid
MS00122611Medicaid
MSH17609Medicare UPIN
MS060000410Medicare ID - Type Unspecified