Healthcare Provider Details

I. General information

NPI: 1578511671
Provider Name (Legal Business Name): MELINDA M. LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BUILDING A, ROOM A3503
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE BUILDING A, ROOM A3503
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4448
  • Fax: 404-778-4860
Mailing address:
  • Phone: 404-712-4448
  • Fax: 404-778-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number027599
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number027599
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: