Provider Demographics
NPI:1609287358
Name:LEWIS, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:M
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY STE 118
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1540
Mailing Address - Country:US
Mailing Address - Phone:865-305-9306
Mailing Address - Fax:865-305-6822
Practice Address - Street 1:501 19TH ST STE 401
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1831
Practice Address - Country:US
Practice Address - Phone:865-331-2020
Practice Address - Fax:865-331-1976
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN626001636390200000X
WAMD60825921207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ064033Medicaid