Provider Demographics
NPI:1093985004
Name:A. EVAN LEWIS PHD MD PC
Entity Type:Organization
Organization Name:A. EVAN LEWIS PHD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-392-5020
Mailing Address - Street 1:1936 BROOKSIDE DR STE D
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4654
Mailing Address - Country:US
Mailing Address - Phone:423-392-5020
Mailing Address - Fax:423-392-5100
Practice Address - Street 1:1936 BROOKSIDE DR STE D
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4654
Practice Address - Country:US
Practice Address - Phone:423-392-5020
Practice Address - Fax:423-392-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN024434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty