Healthcare Provider Details

I. General information

NPI: 1700161072
Provider Name (Legal Business Name): NIKIYA L LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125B VICTORY DR
SWAINSBORO GA
30401-3234
US

IV. Provider business mailing address

1310 BRAMPTON AVE
STATESBORO GA
30458-0851
US

V. Phone/Fax

Practice location:
  • Phone: 478-419-1250
  • Fax:
Mailing address:
  • Phone: 912-871-6206
  • Fax: 912-681-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN184063
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: