Provider Demographics
NPI:1619108206
Name:LEWIS-CARVOUR, MELODI LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELODI
Middle Name:LYNNE
Last Name:LEWIS-CARVOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1434 BROADRICK DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3009
Mailing Address - Country:US
Mailing Address - Phone:706-278-5961
Mailing Address - Fax:706-275-0280
Practice Address - Street 1:170 CURTIS PKWY NE
Practice Address - Street 2:SUITE 1
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2062
Practice Address - Country:US
Practice Address - Phone:706-879-5770
Practice Address - Fax:706-624-4336
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN280363A00000X
GAPA 2660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4720OtherGROUP #