Provider Demographics
NPI:1619222494
Name:LEWIS, SAMANTHA MCWILLIAMS (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MCWILLIAMS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RYAN
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 PADDOCK PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9119
Mailing Address - Country:US
Mailing Address - Phone:678-474-9633
Mailing Address - Fax:678-474-9752
Practice Address - Street 1:3380 PADDOCKS PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9119
Practice Address - Country:US
Practice Address - Phone:678-474-9633
Practice Address - Fax:678-474-9752
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily