Provider Demographics
NPI:1629395520
Name:CALLOWAY-LAWSON, TRACIE SHENELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:SHENELLE
Last Name:CALLOWAY-LAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRACIE
Other - Middle Name:SHENELLE
Other - Last Name:CALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4503 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3026
Mailing Address - Country:US
Mailing Address - Phone:903-792-4003
Mailing Address - Fax:903-792-2230
Practice Address - Street 1:4503 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3026
Practice Address - Country:US
Practice Address - Phone:903-792-4003
Practice Address - Fax:903-792-2230
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7404208000000X
ARE-8026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics