MEDICARE: DR. ELIZABETH TOWNLEY LEWIS DDS

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	122300000X	Dentist	11977	GA

General Provider Information

NPI Number	:	1457353419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH TOWNLEY LEWIS DDS

Provider Business Mailing Address
First Line	:	3523 VINTAGE TRAIL
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189
Country	:	US
Telephone Number	:	678-445-3426
Fax Number	:

Provider Business Practice Location Address
First Line	:	7768 CUMMING HIGHWAY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114
Country	:	US
Telephone Number	:	678-493-2204
Fax Number	:	678-493-2275

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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