Provider Demographics
NPI:1609557800
Name:LAWSON, JORDAN RONNIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RONNIE
Last Name:LAWSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 BUFFALO WEST SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SC
Mailing Address - Zip Code:29321-2709
Mailing Address - Country:US
Mailing Address - Phone:864-426-2447
Mailing Address - Fax:
Practice Address - Street 1:421 EPTING AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4041
Practice Address - Country:US
Practice Address - Phone:864-227-6818
Practice Address - Fax:864-227-0850
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant