Provider Demographics
NPI:1659365062
Name:LAWSON, MARY LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOU
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-537-0020
Mailing Address - Fax:704-537-2144
Practice Address - Street 1:7110 LAWYERS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3906
Practice Address - Country:US
Practice Address - Phone:704-537-0020
Practice Address - Fax:704-537-2144
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038503207Q00000X
NC33188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951256Medicaid
NCB08371Medicare UPIN
NC8951256Medicaid