Provider Demographics
NPI:1972537041
Name:LEWIS, WILLIE JAMES SR (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:JAMES
Last Name:LEWIS
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 POINDEXTER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-3048
Mailing Address - Country:US
Mailing Address - Phone:601-355-0026
Mailing Address - Fax:601-355-0069
Practice Address - Street 1:128 POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39203-3048
Practice Address - Country:US
Practice Address - Phone:601-355-0026
Practice Address - Fax:601-355-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80062213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine