Provider Demographics
NPI:1952690158
Name:LEWIS, MICHAEL T (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1100 NORTHSIDE FORSYTH DR
Mailing Address - Street 2:STE 250
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6012
Mailing Address - Country:US
Mailing Address - Phone:770-667-4337
Mailing Address - Fax:770-667-4338
Practice Address - Street 1:1505 NORTHSIDE FORSYTH BLVD
Practice Address - Street 2:STE 3500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2018-03-08
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Provider Licenses
StateLicense IDTaxonomies
GA6070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003143594GMedicaid
GA003143594HMedicaid
GA003143594IMedicaid
GA003143594GMedicaid