MEDICARE: GLEN LEW MD

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	2080P0207X	Pediatric Hematology & Oncology Physician	41457	GA

General Provider Information

NPI Number	:	1295799161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN LEW MD

Provider Business Mailing Address
First Line	:	5461 MERIDIAN MARK RD STE 400
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3283
Country	:	US
Telephone Number	:	404-785-1112
Fax Number	:	404-785-3600

Provider Business Practice Location Address
First Line	:	5461 MERIDIAN MARK RD STE 400
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3283
Country	:	US
Telephone Number	:	404-785-1112
Fax Number	:	404-785-3600

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	06/06/2022

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Directions to “ GLEN LEW MD” Practice Location

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