Provider Demographics
NPI:1518642339
Name:LEWIS, HENRY WILSON III (MS, MA, CHES)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:WILSON
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:MS, MA, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 PINE CREST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4419
Mailing Address - Country:US
Mailing Address - Phone:305-343-2515
Mailing Address - Fax:
Practice Address - Street 1:5005 PINE CREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4419
Practice Address - Country:US
Practice Address - Phone:305-343-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator