Provider Demographics
NPI:1164832630
Name:LEWIS-ARTHUR, KELLY MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MICHELLE
Last Name:LEWIS-ARTHUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2801 BUFORD HWY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2149
Mailing Address - Country:US
Mailing Address - Phone:770-284-1044
Mailing Address - Fax:404-228-3860
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:770-284-1044
Practice Address - Fax:404-228-3860
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical