=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164348116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JABARI LEWIS
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2026
-----------------------------------------------------
Last Update Date | 06/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 OHIO AVE N STE A
-----------------------------------------------------
City | LIVE OAK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32064-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-853-6714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 KIRKWOOD CIR
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-7125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-853-6714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number | 26R-CPT1620
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------