Provider Demographics
NPI:1578334082
Name:CHOSEWOOD, LEWIS CASEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:CASEY
Last Name:CHOSEWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 GROVE PLACE XING SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8600
Mailing Address - Country:US
Mailing Address - Phone:678-614-7274
Mailing Address - Fax:
Practice Address - Street 1:5625 GROVE PLACE XING SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8600
Practice Address - Country:US
Practice Address - Phone:678-614-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine