Provider Demographics
NPI:1356713705
Name:LAWSON, DELISA
Entity type:Individual
Prefix:
First Name:DELISA
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 LATROBE DR STE 430
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1361
Mailing Address - Country:US
Mailing Address - Phone:704-375-2587
Mailing Address - Fax:704-333-4429
Practice Address - Street 1:1114 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3712
Practice Address - Country:US
Practice Address - Phone:803-787-6911
Practice Address - Fax:704-333-4429
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO005544222Z00000X
NCCPO03842224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist