Provider Demographics
NPI:1245353705
Name:LEWIS MEDICAL ENTERPRISES, INC.
Entity type:Organization
Organization Name:LEWIS MEDICAL ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:678-371-0031
Mailing Address - Street 1:284 MOUNT ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30185-2342
Mailing Address - Country:US
Mailing Address - Phone:678-371-0031
Mailing Address - Fax:770-830-8839
Practice Address - Street 1:4028 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3530
Practice Address - Country:US
Practice Address - Phone:770-942-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095208NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJRXMedicare ID - Type Unspecified
GAA97311Medicare UPIN