Provider Demographics
NPI:1316409758
Name:LEWIS-HAWES, CARLA YALONDA (LMT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:YALONDA
Last Name:LEWIS-HAWES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20014
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-0014
Mailing Address - Country:US
Mailing Address - Phone:706-251-5715
Mailing Address - Fax:
Practice Address - Street 1:1250 MERRY ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3845
Practice Address - Country:US
Practice Address - Phone:706-738-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist