MEDICARE: JOHN EDWARD LEWIS JR. 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	207P00000X	Emergency Medicine Physician	0101236535	VA
2	207P00000X	Emergency Medicine Physician	78406	GA

General Provider Information

NPI Number	:	1497706931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EDWARD LEWIS JR. MD

Provider Business Mailing Address
First Line	:	531 ASBURY CIRCLE HOSPITAL ANNEX-SUITE N340
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-0001
Country	:	US
Telephone Number	:	404-778-2624
Fax Number	:	404-778-2630

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE DEPT OF
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2247
Country	:	US
Telephone Number	:	404-686-7449
Fax Number	:	404-686-4332

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/17/2018

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