Healthcare Provider Details

I. General information

NPI: 1861058141
Provider Name (Legal Business Name): SONYA MARIE LEWIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HIGHWAY 378
LEXINGTON SC
29072-8316
US

IV. Provider business mailing address

PO BOX 749306
ATLANTA GA
30374-9306
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-5533
  • Fax: 803-359-0127
Mailing address:
  • Phone: 803-359-5533
  • Fax: 803-359-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22417
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22417
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: