Healthcare Provider Details

I. General information

NPI: 1861488538
Provider Name (Legal Business Name): RAYMOND E LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VINE CREST CT #1000
GREENWOOD SC
29646-8031
US

IV. Provider business mailing address

105 VINE CREST CT #1000
GREENWOOD SC
29646-8031
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-3350
  • Fax: 864-725-3351
Mailing address:
  • Phone: 864-725-3350
  • Fax: 864-725-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16780
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: