Healthcare Provider Details

I. General information

NPI: 1972869774
Provider Name (Legal Business Name): LILLIANNE MARIE LEWIS DEBNAM MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLIANNE MARIE LEWIS MD, MPH

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 JESSAMINE AVE
GEORGETOWN SC
29440-5837
US

IV. Provider business mailing address

57 JESSAMINE AVE
GEORGETOWN SC
29440-5837
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8686
  • Fax: 843-546-1353
Mailing address:
  • Phone: 843-546-8686
  • Fax: 843-546-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number86761
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number074570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: