Healthcare Provider Details

I. General information

NPI: 1902851512
Provider Name (Legal Business Name): REGINA N LEWIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 S BROAD ST
THOMASVILLE GA
31792-0918
US

IV. Provider business mailing address

PO BOX 2357
THOMASVILLE GA
31799-2357
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-8232
Mailing address:
  • Phone: 229-226-8800
  • Fax: 229-226-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN086419
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: