Healthcare Provider Details

I. General information

NPI: 1902821069
Provider Name (Legal Business Name): DANIEL SCOTT LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E VANN RD SUITE 100
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

PO BOX 37087
BALTIMORE MD
21297-3087
US

V. Phone/Fax

Practice location:
  • Phone: 423-278-1650
  • Fax: 423-787-0243
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number43801
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number43801
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43801
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: