Healthcare Provider Details

I. General information

NPI: 1891007639
Provider Name (Legal Business Name): TORI N SIMMONS LEWIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 W TYVOLA RD
CHARLOTTE NC
28208-7201
US

IV. Provider business mailing address

3506 W TYVOLA RD
CHARLOTTE NC
28208-7201
US

V. Phone/Fax

Practice location:
  • Phone: 704-329-1300
  • Fax:
Mailing address:
  • Phone: 704-329-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number594
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number594
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number594
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: