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General NPI Number Information
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NPI Number | 1285699934
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Entity Type | Individual
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Provider Name | JERRY MADISON LEWTER RN
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 03/27/2011
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Provider Practice Location Address
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Address Line | 3726 ASHFORD DUNWOODY RD NE APT N
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City | ATLANTA
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State | GA
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Zip | 30319-1873
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Country | US
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Telephone | 678-404-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 3726 ASHFORD DUNWOODY RD NE APT N
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City | ATLANTA
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State | GA
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Zip | 30319-1873
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Country | US
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Telephone | 678-404-2343
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Fax |
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number | RN158379
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN158379
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License Number State | GA
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