Healthcare Provider Details

I. General information

NPI: 1477858181
Provider Name (Legal Business Name): SANA, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 E PLAZA DR
TALLAHASSEE FL
32308-5301
US

IV. Provider business mailing address

602 RIVERVIEW DR
CARRABELLE FL
32322-5053
US

V. Phone/Fax

Practice location:
  • Phone: 850-228-5048
  • Fax:
Mailing address:
  • Phone: 850-228-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES ALAN LEWIS
Title or Position: DOCTOR
Credential: M.D.
Phone: 850-228-5048