Provider Demographics
NPI:1245715630
Name:LEWIS, BARRY J (PA-C 188832)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C 188832
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COOSA MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-5752
Mailing Address - Country:US
Mailing Address - Phone:706-835-1845
Mailing Address - Fax:
Practice Address - Street 1:12 COOSA MEADOW DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-5752
Practice Address - Country:US
Practice Address - Phone:706-835-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD001350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant