Healthcare Provider Details

I. General information

NPI: 1174773568
Provider Name (Legal Business Name): LATOYA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9067 VETERANS PARKWAY
COLUMBUS GA
31901
US

IV. Provider business mailing address

5780 MILGEN RD APT. 701
COLUMBUS GA
31907-2431
US

V. Phone/Fax

Practice location:
  • Phone: 706-641-9663
  • Fax: 706-494-7072
Mailing address:
  • Phone: 706-304-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: