Provider Demographics
NPI:1063472967
Name:LEWIS, JEFFERY DUN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DUN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:993D JOHNSON FERRY RD
Mailing Address - Street 2:STE 440
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-257-0799
Mailing Address - Fax:404-503-2280
Practice Address - Street 1:993D JOHNSON FERRY RD
Practice Address - Street 2:STE 440
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-257-0799
Practice Address - Fax:404-503-2280
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0418732080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134940OtherAETNA HMO POS
1422312OtherUNITED HEALTH CARE
GA000709497HMedicaid
52508068010OtherBLUE CHOICE PROVIDER IDS
5433953006OtherCIGNA
5757428OtherAETNA MC PPO
080685OtherBLUE CHOICE FAC INS
1789OtherKAISER
F97329Medicare UPIN