Healthcare Provider Details

I. General information

NPI: 1033248976
Provider Name (Legal Business Name): LAWRENCE K. LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BARCLAY DR
MADISON GA
30650-4621
US

IV. Provider business mailing address

PO BOX 552
MADISON GA
30650-0552
US

V. Phone/Fax

Practice location:
  • Phone: 706-342-1561
  • Fax: 706-342-3917
Mailing address:
  • Phone: 706-342-1561
  • Fax: 706-342-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number007834
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: