Provider Demographics
NPI:1538823919
Name:LAWSON, COREY DANYALL
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:DANYALL
Last Name:LAWSON
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:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1282
Mailing Address - Country:US
Mailing Address - Phone:252-327-0982
Mailing Address - Fax:252-582-6020
Practice Address - Street 1:112 W KING ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4830
Practice Address - Country:US
Practice Address - Phone:252-643-2363
Practice Address - Fax:252-582-6020
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator