Provider Demographics
NPI:1437349487
Name:M. KEITH LEWIS, M.D.
Entity Type:Organization
Organization Name:M. KEITH LEWIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-783-2297
Mailing Address - Street 1:292 INDUSTRIAL BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-8002
Mailing Address - Country:US
Mailing Address - Phone:478-783-2297
Mailing Address - Fax:478-783-2296
Practice Address - Street 1:292 INDUSTRIAL BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-8002
Practice Address - Country:US
Practice Address - Phone:478-783-2297
Practice Address - Fax:478-783-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7011OtherMEDICARE GROUP NUMBER
GAGRP7011OtherMEDICARE GROUP NUMBER