Healthcare Provider Details

I. General information

NPI: 1104994813
Provider Name (Legal Business Name): LESLIE SHARP LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GILMER ST
REIDSVILLE NC
27320-3809
US

IV. Provider business mailing address

PO BOX 890195
CHARLOTTE NC
28289-0195
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-6196
  • Fax:
Mailing address:
  • Phone: 336-342-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103354
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: