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General NPI Number Information
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NPI Number | 1760662332
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Entity Type | Organization
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Legal Business Name | LEWIS MEDICAL ENTERPRISES
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 4028 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3530
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Country | US
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Telephone | 678-371-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 284 MOUNT ZION CHURCH RD
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City | WHITESBURG
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State | GA
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Zip | 30185-2342
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Country | US
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Telephone | 678-371-0031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUY LEWIS
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Credential |
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Telephone | 678-371-0031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN095208NP
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License Number State | GA
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