Physician Compare National (NPI:1558479253)

HEALTHCARE PROVIDER: FULTON D LEWIS III DMD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1558479253
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426195595
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110203000451
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LEWIS
	Individual professional last name
Provider First Name	FULTON
	Individual professional first name
Provider Middle Name	DEWITT
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL UNIV OF SOUTH CAROLINA COL OF DENTAL MED
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ORAL SURGERY ASSOCIATES AND DENTAL IMPLANT CENTER PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9537154968
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	7135 FLOYD NEST
	Group Practice or individual's line 1 address
City	COVINGTON
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300141578
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7707872444
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110076
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DEKALB MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y