Provider Demographics
NPI:1043787476
Name:LEWIS, THOMAS M (MED)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 HILLTOP AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630
Mailing Address - Country:US
Mailing Address - Phone:276-970-2505
Mailing Address - Fax:
Practice Address - Street 1:147 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651
Practice Address - Country:US
Practice Address - Phone:276-970-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health