Healthcare Provider Details

I. General information

NPI: 1053010256
Provider Name (Legal Business Name): JEFFREY THOMAS LEWIS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/25/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7680 DANNAHER DR.
POWELL TN
37849-4052
US

IV. Provider business mailing address

7121 REGAL LN SUITE 200A
KNOXVILLE TN
37918-5804
US

V. Phone/Fax

Practice location:
  • Phone: 865-521-8050
  • Fax: 865-544-5816
Mailing address:
  • Phone: 865-521-8050
  • Fax: 865-544-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064392
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6077
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: