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General NPI Number Information
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NPI Number | 1184995102
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Entity Type | Individual
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Provider Name | GWENDOLYN JEANETTE LEWIS NP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 423-664-4460
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Fax | 423-648-5675
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Provider Business Mailing Address
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Address Line | 902 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2724
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Country | US
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Telephone | 423-664-4460
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Fax | 423-648-5675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | RN120677
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License Number State | GA
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