Provider Demographics
NPI:1861685877
Name:LAWSON, JIMBA (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMBA
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:677 CHURCH ST NE # 111
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-793-7750
Practice Address - Fax:770-793-7755
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059894208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111260768BMedicaid
GA111260768EMedicaid
GA2173855OtherCIGNA
GA425575OtherWELLCARE
GA111260768FMedicaid
GA111260768GMedicaid
GA111260768HMedicaid
GAP00468642OtherMEDICARE RAILROAD
GA01157487OtherAMERIGROUP
GA2850783OtherUHC
GA9749109OtherAETNA
GA52230211OtherBCBS
GA425575OtherWELLCARE