Provider Demographics
NPI:1063974863
Name:ACHALA, LAWSON
Entity type:Individual
Prefix:
First Name:LAWSON
Middle Name:
Last Name:ACHALA
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 1:4516 CROOKED RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4079
Mailing Address - Country:US
Mailing Address - Phone:214-714-0105
Mailing Address - Fax:
Practice Address - Street 1:4516 CROOKED RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4079
Practice Address - Country:US
Practice Address - Phone:214-714-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX950529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse