Provider Demographics
NPI:1003256983
Name:LEWIS, AUSTIN J (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:706 DIXIE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3858
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-812-5735
Practice Address - Street 1:157 CLINIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-834-3336
Practice Address - Fax:770-832-2331
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA080683208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery