Provider Demographics
NPI:1568400257
Name:LEWANDOWSKI, JEFFREY (DPT, MTC, ATC, SCS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:DPT, MTC, ATC, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 MCGINNIS FERRY ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:770-495-0610
Mailing Address - Fax:770-495-0806
Practice Address - Street 1:6920 MCGINNIS FERRY ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-495-0610
Practice Address - Fax:770-495-0806
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT2277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA687736OtherBCBS GA
GA781811237AMedicaid
GA781811237AMedicaid