Provider Demographics
NPI:1215211479
Name:LEWIS, TILINA (CNA, PCT)
Entity Type:Individual
Prefix:
First Name:TILINA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA, PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4395
Mailing Address - Country:US
Mailing Address - Phone:678-521-8849
Mailing Address - Fax:
Practice Address - Street 1:2497 BERMUDA DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4395
Practice Address - Country:US
Practice Address - Phone:678-521-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHO003808374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide