Healthcare Provider Details

I. General information

NPI: 1043786221
Provider Name (Legal Business Name): MARSHA M LEWIS MPH, RDN, CDE, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 HILLCREST PKWY
DUBLIN GA
31021-4206
US

IV. Provider business mailing address

908 HILLCREST PKWY
DUBLIN GA
31021-4206
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-7411
  • Fax: 478-274-8390
Mailing address:
  • Phone: 478-272-7411
  • Fax: 478-274-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: