Healthcare Provider Details

I. General information

NPI: 1235228578
Provider Name (Legal Business Name): RODGER P LEWIS M D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BISHOP ST
UNION CITY TN
38261
US

IV. Provider business mailing address

PO BOX 870
UNION CITY TN
38281
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-9231
  • Fax: 731-885-6318
Mailing address:
  • Phone: 731-885-9231
  • Fax: 731-885-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD000007577
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD000007577
License Number StateTN

VIII. Authorized Official

Name: MRS. FRANKIE J THOMAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-885-9231