Provider Demographics
NPI:1326524687
Name:LAWSON, STEPHANIE WOLFRUM (FNP-C)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:WOLFRUM
Last Name:LAWSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752
Mailing Address - Country:US
Mailing Address - Phone:706-657-3200
Mailing Address - Fax:706-657-3201
Practice Address - Street 1:12415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752
Practice Address - Country:US
Practice Address - Phone:706-657-3200
Practice Address - Fax:706-657-3201
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151772207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine