Healthcare Provider Details

I. General information

NPI: 1154117828
Provider Name (Legal Business Name): KATIE LYNN LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 LAKESHORE DR
MONROE GA
30655-7710
US

IV. Provider business mailing address

1412 MILSTEAD AVE NE
CONYERS GA
30012-3877
US

V. Phone/Fax

Practice location:
  • Phone: 404-630-8531
  • Fax:
Mailing address:
  • Phone: 770-918-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN295611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: