Provider Demographics
NPI:1225198153
Name:LEWIS, LELA I (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELA
Middle Name:I
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 ANGIER CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1068
Mailing Address - Country:US
Mailing Address - Phone:404-438-2296
Mailing Address - Fax:404-733-0819
Practice Address - Street 1:1014 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1812
Practice Address - Country:US
Practice Address - Phone:404-753-3339
Practice Address - Fax:404-753-3338
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0097521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00263645DMedicaid