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General NPI Number Information
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NPI Number | 1962739086
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Entity Type | Organization
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Legal Business Name | RICHARD J. LEWIS, D.O., P.C.
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 166 MEMORIAL DR
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City | JESUP
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State | GA
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Zip | 31545-0101
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Country | US
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Telephone | 912-427-2643
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Fax | 912-427-2644
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Provider Business Mailing Address
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Address Line | PO BOX 1113
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City | JESUP
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State | GA
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Zip | 31598-1113
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Country | US
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Telephone | 912-427-2643
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Fax | 912-427-2644
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Authorized Official
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Title or Position | DO
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Name | RICHARD JOHN LEWIS
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Credential | DO
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Telephone | 912-427-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 63368
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License Number State | GA
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