Healthcare Provider Details

I. General information

NPI: 1174963425
Provider Name (Legal Business Name): MARCIA L LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1786
US

IV. Provider business mailing address

1582 BARRINGTON VW
STONE MOUNTAIN GA
30087-1846
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-8377
  • Fax:
Mailing address:
  • Phone: 770-826-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN044830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: