Provider Demographics
NPI:1003010976
Name:LEWIS, BRANDI (MD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 ERNEST W BARRETT PKWY NW STE 102B
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4534
Mailing Address - Country:US
Mailing Address - Phone:678-354-2273
Mailing Address - Fax:
Practice Address - Street 1:1180 ERNEST W BARRETT PKWY NW STE 102B
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:678-354-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094508208000000X
ARE-10688208000000X
GA76750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221871001Medicaid