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General NPI Number Information
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NPI Number | 1245241975
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Entity Type | Individual
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Provider Name | ARLENE ANNETTA LEWIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 1383 MANCHESTER DR NE STE B
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City | CONYERS
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State | GA
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Zip | 30012
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Country | US
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Telephone | 770-981-2443
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Fax | 770-981-2478
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Provider Business Mailing Address
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Address Line | 1383 MANCHESTER DR NE STE B
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City | CONYERS
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State | GA
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Zip | 30012-3882
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Country | US
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Telephone | 770-981-2443
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Fax | 770-981-2478
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 043236
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License Number State | GA
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