Healthcare Provider Details

I. General information

NPI: 1063575322
Provider Name (Legal Business Name): RANI LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTOPHER RANDOLPH MD

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE STE 802
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

1407 UNION AVE STE 802
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-259-5341
  • Fax: 901-259-5344
Mailing address:
  • Phone: 901-259-5341
  • Fax: 901-259-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number024718
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number024718
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: