Provider Demographics
NPI:1487081105
Name:LEWIS-SIMON, MICHELLE (FNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:LEWIS-SIMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 JIM OWENS RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2324
Mailing Address - Country:US
Mailing Address - Phone:678-574-5843
Mailing Address - Fax:
Practice Address - Street 1:1605 MULKEY RD BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1127
Practice Address - Country:US
Practice Address - Phone:470-956-3760
Practice Address - Fax:678-398-1930
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily