MEDICARE: MALAYSIA MARIE LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC010875	GA

General Provider Information

NPI Number	:	1740120211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAYSIA MARIE LEWIS

Provider Business Mailing Address
First Line	:	2296 HENDERSON MILL RD NE STE 116
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2296 HENDERSON MILL RD NE STE 116
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2739
Country	:	US
Telephone Number	:	803-667-4406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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