Provider Demographics
NPI:1073633509
Name:LEWIS, LONAS EDWARD II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LONAS
Middle Name:EDWARD
Last Name:LEWIS
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2618 DIANA CIR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1416
Mailing Address - Country:US
Mailing Address - Phone:229-382-4528
Mailing Address - Fax:
Practice Address - Street 1:3251 INNER PERIMETER RD STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1026
Practice Address - Country:US
Practice Address - Phone:229-259-0006
Practice Address - Fax:229-259-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant