Provider Demographics
NPI:1558123802
Name:LEWIS NUNEZ, ROXANN SHERIESE
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:SHERIESE
Last Name:LEWIS NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 GREENTREE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7250
Mailing Address - Country:US
Mailing Address - Phone:770-560-2308
Mailing Address - Fax:
Practice Address - Street 1:4692 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6150
Practice Address - Country:US
Practice Address - Phone:770-489-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC074692183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician