Healthcare Provider Details

I. General information

NPI: 1003256983
Provider Name (Legal Business Name): AUSTIN J LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 302
CARROLLTON GA
30117
US

IV. Provider business mailing address

706 DIXIE ST STE 220
CARROLLTON GA
30117-3858
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-3336
  • Fax: 770-832-2331
Mailing address:
  • Phone: 770-838-8710
  • Fax: 770-812-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number080683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: