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General NPI Number Information
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NPI Number | 1851599476
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Entity Type | Individual
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Provider Name | CHAD EDWARD LEWIS P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 17007 GA-67
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-681-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 17007 GA-67
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-681-2500
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1573
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA064638
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5094
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License Number State | GA
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