MEDICARE: DR. JUSTIN WALTON LEWIS MD

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	207V00000X	Obstetrics & Gynecology Physician	46995	AL

General Provider Information

NPI Number	:	1871081398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN WALTON LEWIS MD

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:	334-747-4159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 E SOUTH BLVD STE 806
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2007
Country	:	US
Telephone Number	:	334-747-8920
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	08/07/2023

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