Provider Demographics
NPI:1073040283
Name:LEWIS, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412A RUSSELL PKWY # 237
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5583
Mailing Address - Country:US
Mailing Address - Phone:478-420-1499
Mailing Address - Fax:855-450-1224
Practice Address - Street 1:919 CORDER RD APT 44
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7176
Practice Address - Country:US
Practice Address - Phone:478-420-1499
Practice Address - Fax:855-450-1224
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver