=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477858181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANA, L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2011
-----------------------------------------------------
Last Update Date | 01/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2418 E PLAZA DR
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-228-5048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 RIVERVIEW DR
-----------------------------------------------------
City | CARRABELLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32322-5053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-228-5048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. CHARLES ALAN LEWIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-228-5048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------