Provider Demographics
NPI:1063480267
Name:LEWIS, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HOSPITAL DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8007
Mailing Address - Country:US
Mailing Address - Phone:478-742-5331
Mailing Address - Fax:478-750-1387
Practice Address - Street 1:380 HOSPITAL DR STE 320
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8007
Practice Address - Country:US
Practice Address - Phone:478-742-5331
Practice Address - Fax:478-750-1387
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87147208800000X
GA052318208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1063480267OtherNPI INDIVIDUAL
GA1962538850OtherNPI GROUP
FL266608100Medicaid
GA1063480267OtherNPI INDIVIDUAL
GA202I340244Medicare PIN
GA1962538850OtherNPI GROUP