MEDICARE: JOYCELIA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255828539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCELIA LEWIS

Provider Business Mailing Address
First Line	:	8491 HOSPITAL DR STE 301
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-2412
Country	:	US
Telephone Number	:	770-325-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4827 OLD NATIONAL HWY # 1216
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-6234
Country	:	US
Telephone Number	:	770-325-4070
Fax Number	:	404-908-0340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	11/02/2020

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Directions to “ JOYCELIA LEWIS ” Practice Location

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