Provider Demographics
NPI:1821439985
Name:LEWIS, CHANTAL ANEKA RAHEEDA (MD)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:ANEKA RAHEEDA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 REED RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-6310
Mailing Address - Country:US
Mailing Address - Phone:706-278-1622
Mailing Address - Fax:706-272-6445
Practice Address - Street 1:475 REED RD STE 104
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-6310
Practice Address - Country:US
Practice Address - Phone:706-278-1622
Practice Address - Fax:706-272-6445
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079901207RE0101X, 207R00000X
PAMT205027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine