Provider Demographics
NPI:1750677332
Name:LEWIS, JENNIFER ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANTHONY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-6838
Practice Address - Country:US
Practice Address - Phone:615-936-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01311207R00000X
390200000X
TN55653207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750677332Medicaid
NC1750677332OtherTRICARE
NC282011OtherMEDCOST
NC5714799OtherAETNA
NC1750677332OtherVIRGINIA MEDICAID
NC1869WOtherBCBS
ND5115648OtherUNITED HEALTHCARE
SCQ01311OtherSC MEDICAID
NCP01364607OtherRR MEDICARE
ND5115648OtherUNITED HEALTHCARE