Provider Demographics
NPI:1730171141
Name:LAWHON, REET IV (MD)
Entity type:Individual
Prefix:
First Name:REET
Middle Name:
Last Name:LAWHON
Suffix:IV
Gender:M
Credentials:MD
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 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34902207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3865299Medicaid
4059535OtherBLUE SHIELD OF TENNESSEE
TN0100OtherJOHN DEERE
293135OtherANTHEM BCBS
NC5900349Medicaid
VA010020051Medicaid
100035914OtherPHP TENNCARE
00013859OtherNHC CARE ADMINISTRATORS
KY64034663OtherKY MEDICAID
293135OtherANTHEM BCBS
00013859OtherNHC CARE ADMINISTRATORS
TN3865299Medicaid