Provider Demographics
NPI:1093828956
Name:LEWIS, CURTIS ALAN (MD, MBA, JD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:ALAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD, MBA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PIEDMONT AVE NE
Mailing Address - Street 2:UNIT 2208
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3327
Mailing Address - Country:US
Mailing Address - Phone:404-616-4261
Mailing Address - Fax:404-616-6828
Practice Address - Street 1:80 JESSIE HILL JR. DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-4261
Practice Address - Fax:404-616-6828
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA304992085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30499OtherMEDICAL LICENSE
GAF32264Medicare UPIN