Healthcare Provider Details

I. General information

NPI: 1255247144
Provider Name (Legal Business Name): ZHAKWON MICHAEL LEWIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4404
US

IV. Provider business mailing address

2306 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4404
US

V. Phone/Fax

Practice location:
  • Phone: 850-250-0021
  • Fax: 850-250-0022
Mailing address:
  • Phone: 850-250-0021
  • Fax: 850-250-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: