Healthcare Provider Details

I. General information

NPI: 1407464183
Provider Name (Legal Business Name): LORI DARNELLE LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI DARNELLE THORNTON NP

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5631 TURNSTONE DR SW
CONYERS GA
30094-4765
US

IV. Provider business mailing address

5631 TURNSTONE DR SW
CONYERS GA
30094-4765
US

V. Phone/Fax

Practice location:
  • Phone: 225-505-5717
  • Fax: 470-437-3209
Mailing address:
  • Phone: 470-336-0474
  • Fax: 470-437-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN276881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: