Healthcare Provider Details

I. General information

NPI: 1174580062
Provider Name (Legal Business Name): LEWIS JEFFERS FOWLKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAINT VINCENTS DR SUITE 500
BIRMINGHAM AL
35205-1620
US

IV. Provider business mailing address

800 SAINT VINCENTS DR SUITE 500
BIRMINGHAM AL
35205-1620
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8334
  • Fax: 205-933-8466
Mailing address:
  • Phone: 205-933-8334
  • Fax: 205-933-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8800
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: