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NPI Code Detail

MEDICARE: MR. CLIFFORD D. LEWIS PA

MEDICARE:  MR. CLIFFORD D. LEWIS  PA
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
1363AM0700XMedical Physician Assistant003825GA

General Provider Information

NPI Number : 1881696144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLIFFORD D. LEWIS PA
Provider Business Mailing Address
First Line : 5556 SARATOGA DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-7405
Country : US
Telephone Number : 706-689-7809
Fax Number :
Provider Business Practice Location Address
First Line : 1061 HARMON AVE
Second Line : STE 1003
City : FORT STEWART
State : GA
Zip : 31314-5604
Country : US
Telephone Number : 912-435-6965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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Directions to “ MR. CLIFFORD D. LEWIS PA” Practice Location

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