Provider Demographics
NPI:1326237355
Name:HENRY J. LEWIS, MD PC
Entity Type:Organization
Organization Name:HENRY J. LEWIS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:770-532-0666
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:770-532-0666
Mailing Address - Fax:770-532-0666
Practice Address - Street 1:5606 CAPTAINS CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-8197
Practice Address - Country:US
Practice Address - Phone:770-532-0666
Practice Address - Fax:770-532-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049052261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRBWOtherMEDICARE P-TAN
GADC0733OtherRAILROAD MCARE PIN
GA000875531BMedicaid
GA08BBRBWOtherMEDICARE P-TAN
GAGRP6557Medicare PIN