Provider Demographics
NPI:1265603914
Name:LAWSON, STEPHEN TIMOTHY (OPA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TIMOTHY
Last Name:LAWSON
Suffix:
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E RAVINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3826
Mailing Address - Country:US
Mailing Address - Phone:342-224-3210
Mailing Address - Fax:
Practice Address - Street 1:121 E RAVINE RD STE 200
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3826
Practice Address - Country:US
Practice Address - Phone:342-224-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant