Healthcare Provider Details

I. General information

NPI: 1649767658
Provider Name (Legal Business Name): DARRON RICARDO LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 QUARTZ DR STE 103B
VILLA RICA GA
30180-3201
US

IV. Provider business mailing address

PO BOX 100183
GAINESVILLE FL
32610-0183
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-3530
  • Fax: 770-812-3579
Mailing address:
  • Phone: 352-392-0140
  • Fax: 352-292-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME169586
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number84683
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number84683
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: