Provider Demographics
NPI:1386649119
Name:LEWIS, SAMUEL V (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:V
Last Name:LEWIS
Suffix:
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 1:301 MED TECH PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2364
Mailing Address - Country:US
Mailing Address - Phone:423-794-1300
Mailing Address - Fax:423-794-1398
Practice Address - Street 1:301 MED TECH PKWY
Practice Address - Street 2:STE 200
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2364
Practice Address - Country:US
Practice Address - Phone:423-794-1300
Practice Address - Fax:423-794-1398
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN5904207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032875Medicaid
TN3032878Medicaid
TN3032878Medicaid
TN3032878Medicare PIN