Provider Demographics
NPI:1851599476
Name:LEWIS, CHAD EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:EDWARD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2166
Mailing Address - Country:US
Mailing Address - Phone:770-979-8080
Mailing Address - Fax:770-979-8099
Practice Address - Street 1:1600 MEDICAL WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2166
Practice Address - Country:US
Practice Address - Phone:770-979-8080
Practice Address - Fax:770-979-8099
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1573363A00000X
GA5094363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA903741496EMedicaid