Provider Demographics
NPI:1508051772
Name:LEWIS, JEANNE LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:LYNNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N STATE OF FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6034
Mailing Address - Country:US
Mailing Address - Phone:423-431-7047
Mailing Address - Fax:423-979-0569
Practice Address - Street 1:403 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6034
Practice Address - Country:US
Practice Address - Phone:423-431-7047
Practice Address - Fax:423-979-0569
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN436022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00877916OtherRR MEDICARE
VA1508051772Medicaid
TN1511958Medicaid
TN1511958Medicaid
SD3002673IMedicare PIN