MEDICARE: MRS. ANNIE MAE LEWIS APRN, RN, COSM

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN066472	GA

General Provider Information

NPI Number	:	1811505480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNIE MAE LEWIS APRN, RN, COSM

Provider Business Mailing Address
First Line	:	1968 NORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1525
Country	:	US
Telephone Number	:	706-225-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 NORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1525
Country	:	US
Telephone Number	:	706-315-9839
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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