Provider Demographics
NPI:1659028793
Name:JOHNSON, LAWSON
Entity Type:Individual
Prefix:
First Name:LAWSON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 SPARKMAN RD LOT 19
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-4747
Mailing Address - Country:US
Mailing Address - Phone:813-965-3500
Mailing Address - Fax:
Practice Address - Street 1:1912 SPARKMAN RD LOT 19
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-4747
Practice Address - Country:US
Practice Address - Phone:813-965-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider