Healthcare Provider Details

I. General information

NPI: 1124000419
Provider Name (Legal Business Name): BRIAN C LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 LEXINGTON AVE SUITE A
THOMASVILLE NC
27360-2784
US

IV. Provider business mailing address

1219 LEXINGTON AVE SUITE A
THOMASVILLE NC
27360-2784
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-7148
  • Fax: 336-475-7031
Mailing address:
  • Phone: 336-475-7148
  • Fax: 336-475-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200200720
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: