Provider Demographics
NPI:1720396070
Name:LEWIS, ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E WEST CONNECTOR STE. 815
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8190
Mailing Address - Country:US
Mailing Address - Phone:678-437-3247
Mailing Address - Fax:
Practice Address - Street 1:2222 E WEST CONNECTOR APT 815
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6801
Practice Address - Country:US
Practice Address - Phone:678-437-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No251E00000XAgenciesHome Health