Provider Demographics
NPI:1326057621
Name:LEWIS, HENRY JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOSEPH
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 CAPTAINS CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-8197
Mailing Address - Country:US
Mailing Address - Phone:770-654-3400
Mailing Address - Fax:
Practice Address - Street 1:5606 CAPTAINS CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504
Practice Address - Country:US
Practice Address - Phone:770-654-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49052207Q00000X, 207Q00000X
GA049052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000875531BMedicaid
GAP00146315OtherRAILROAD MEDICARE
GA08BBRBWMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAH05706Medicare UPIN