Provider Demographics
NPI:1689287682
Name:LEWIS, TERRY II (LPN)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:LEWIS
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 RIVER OVERLOOK WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6237
Mailing Address - Country:US
Mailing Address - Phone:404-462-1233
Mailing Address - Fax:
Practice Address - Street 1:4935 RIVER OVERLOOK WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6237
Practice Address - Country:US
Practice Address - Phone:404-462-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 172V00000X, 372600000X, 374U00000X
GALPN090245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker
No372600000XNursing Service Related ProvidersAdult Companion