Healthcare Provider Details

I. General information

NPI: 1720446206
Provider Name (Legal Business Name): KIMBERLY LEWIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

IV. Provider business mailing address

997 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-8664
  • Fax:
Mailing address:
  • Phone: 706-721-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: