Healthcare Provider Details

I. General information

NPI: 1801207360
Provider Name (Legal Business Name): GEORGE WELDON LEWIS V.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 05/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 ABSOLUTE DR
HILLIARD FL
32046-6314
US

IV. Provider business mailing address

4842 ABSOLUTE DR
HILLIARD FL
32046-6314
US

V. Phone/Fax

Practice location:
  • Phone: 904-845-1985
  • Fax: 904-845-3099
Mailing address:
  • Phone: 904-845-1985
  • Fax: 904-845-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVM6786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: