Healthcare Provider Details

I. General information

NPI: 1669121307
Provider Name (Legal Business Name): HENRY LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 LIVE OAK DR
LITTLE RIVER SC
29566-9138
US

IV. Provider business mailing address

PO BOX 547
LITTLE RIVER SC
29566-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8000
  • Fax:
Mailing address:
  • Phone: 843-663-8000
  • Fax: 877-229-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number96723
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: