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NPI Code Detail

MEDICARE: DORNEL J LEWIS NURSE PRACTITIONER

MEDICARE: DORNEL J LEWIS NURSE PRACTITIONER
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
1363L00000XNurse PractitionerRN248615GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerRN248615GA
3163W00000XRegistered NurseRN248615GA

General Provider Information

NPI Number : 1861462624
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORNEL J LEWIS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 304 SUMMIT HEIGHTS CT
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2973
Country : US
Telephone Number : 404-254-8250
Fax Number :
Provider Business Practice Location Address
First Line : 2808 E ATLANTA RD
Second Line : SUITE 344
City : ELLENWOOD
State : GA
Zip : 30294-2780
Country : US
Telephone Number : 404-434-0401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 12/19/2025

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