Provider Demographics
NPI:1356943484
Name:LEWANDOWSKI, JOHN RICHARD (PC-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:PC-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:775 POPLAR RD STE 310
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8303
Mailing Address - Country:US
Mailing Address - Phone:770-251-2590
Mailing Address - Fax:770-251-1490
Practice Address - Street 1:775 POPLAR RD STE 310
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8303
Practice Address - Country:US
Practice Address - Phone:770-251-2590
Practice Address - Fax:770-251-1490
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant