Provider Demographics
NPI:1225416258
Name:LEWIS, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FERRY RD
Mailing Address - Street 2:STE 1040
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:770-292-3460
Mailing Address - Fax:404-300-2317
Practice Address - Street 1:980 JOHNSON FERRY RD
Practice Address - Street 2:STE 1040
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:770-292-3460
Practice Address - Fax:404-300-2317
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003160422CMedicaid
GA003160422DMedicaid
GA003160422AMedicaid
GA003160422DMedicaid