Provider Demographics
NPI:1134114044
Name:LAWSON, WILLIE TRAVIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:TRAVIS
Last Name:LAWSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 SPRING VALLEY DRIVE HERSHEL 'WOODY' WILLIAMS VA ME
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:304-429-0262
Practice Address - Street 1:1540 SPRING VALLEY DRIVE HERSHEL 'WOODY' WILLIAMS VA ME
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-429-0262
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64269939Medicaid
OH2888559Medicaid