MEDICARE: MS. TAMARA DAVIS LEWIS

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1932876679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA DAVIS LEWIS

Provider Business Mailing Address
First Line	:	7221 PREAKNESS STAKES LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8200
Country	:	US
Telephone Number	:	980-477-2976
Fax Number	:

Provider Business Practice Location Address
First Line	:	7221 PREAKNESS STAKES LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8200
Country	:	US
Telephone Number	:	980-477-2976
Fax Number	:

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

Provider Enumeration Date	:	08/29/2021
Last Update Date	:	08/29/2021

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