Provider Demographics
NPI:1255703203
Name:LAWAL, MOJEED
Entity type:Individual
Prefix:
First Name:MOJEED
Middle Name:
Last Name:LAWAL
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 1:250 HICKORY HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3008
Mailing Address - Country:US
Mailing Address - Phone:720-212-3667
Mailing Address - Fax:
Practice Address - Street 1:250 HICKORY HOLLOW PL
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3008
Practice Address - Country:US
Practice Address - Phone:720-212-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN189714172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver