Provider Demographics
NPI:1467622639
Name:LEWIS, SUSAN LEWIS (BS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEWIS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LANETTE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:256-582-3216
Practice Address - Street 1:508 GREGORY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4239
Practice Address - Country:US
Practice Address - Phone:256-259-1774
Practice Address - Fax:256-259-0761
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator