MEDICARE: SYDNEY BRENTS LEWIS PA-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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	4928	TN

General Provider Information

NPI Number	:	1447902523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY BRENTS LEWIS PA-C

Provider Business Mailing Address
First Line	:	11060 LEBANON RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-5525
Country	:	US
Telephone Number	:	615-288-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	11060 LEBANON RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-5525
Country	:	US
Telephone Number	:	615-288-7743
Fax Number	:

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

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	05/06/2026

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Directions to “ SYDNEY BRENTS LEWIS PA-C” Practice Location

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