Provider Demographics
NPI:1801257647
Name:LAWSON, TINA L (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:L
Last Name:LAWSON
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6221 SELBORN DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9401
Mailing Address - Country:US
Mailing Address - Phone:404-665-6185
Mailing Address - Fax:404-344-5132
Practice Address - Street 1:6221 SELBORN DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9401
Practice Address - Country:US
Practice Address - Phone:404-665-6185
Practice Address - Fax:404-344-5132
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC01274011744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management