Individual
MR. GLENNIS DARRELL LAWSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN-CRNA
Contact information
Practice address
919 E. CENTRAL AVENUE, LAFOLLETTE, TN 37766-2055
(865) 777-0909
(865) 777-0910
Mailing address
12752 KINGSTON PIKE, STE E202, KNOXVILLE, TN 37934-0948
(865) 777-0909
(865) 777-0910
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
11154
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
128612
TN
367500000X
Certified Registered Nurse Anesthetist
APN11154
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1506017
—
TN
01
—
4110437
IND BC PROVIDER NUMBER
TN
01
—
4178543
BLUE CROSS/BLUE SHIELD
TN
05
—
74010061
—
KY
05
—
74010661
—
KY
01
—
P00632153
RAILROAD MEDICARE
—
Enumeration date
11/10/2006
Last updated
03/22/2016
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