=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164832630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY MICHELLE LEWIS-ARTHUR PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3355 LENOX RD NE STE 1000
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-284-1044
-----------------------------------------------------
Fax | 404-228-3860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 BUFORD HWY NE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30329-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-284-1044
-----------------------------------------------------
Fax | 404-228-3860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY003785
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------