=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104990795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDRE CHRISTOPHER LEWIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 01/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 INDUSTRIAL BLVD. HOSPITALISTS AT FAIRVIEW PARK LLC
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-274-3925
-----------------------------------------------------
Fax | 478-274-3663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 INDUSTRIAL BLVD. HOSPITALISTS AT FAIRVIEW PARK LLC
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-274-3925
-----------------------------------------------------
Fax | 478-274-3663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 040457
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------