Healthcare Provider Details

I. General information

NPI: 1063472967
Provider Name (Legal Business Name): JEFFERY DUN LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993D JOHNSON FERRY RD STE 440
ATLANTA GA
30342
US

IV. Provider business mailing address

993D JOHNSON FERRY RD STE 440
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0799
  • Fax: 404-503-2280
Mailing address:
  • Phone: 404-257-0799
  • Fax: 404-503-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number041873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: