Healthcare Provider Details

I. General information

NPI: 1881777068
Provider Name (Legal Business Name): LLEWELYN A LEWIS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 NORTH LEG ROAD
AUGUSTA GA
30909
US

IV. Provider business mailing address

1916 NORTH LEG ROAD
AUGUSTA GA
30909
US

V. Phone/Fax

Practice location:
  • Phone: 706-667-4285
  • Fax: 706-667-4607
Mailing address:
  • Phone: 706-667-4285
  • Fax: 706-667-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN026041 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: