MEDICARE: JAMIE BONNER LEWIS FNP-C

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	363LF0000X	Family Nurse Practitioner	RN080642	GA

General Provider Information

NPI Number	:	1447758305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE BONNER LEWIS FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1038
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-1038
Country	:	US
Telephone Number	:	706-660-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 RIVER RD STE 301
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3353
Country	:	US
Telephone Number	:	706-494-0694
Fax Number	:	706-494-0695

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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