Provider Demographics
NPI:1669294187
Name:LEWIS, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 EDMONTON PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0135
Mailing Address - Country:US
Mailing Address - Phone:937-397-2988
Mailing Address - Fax:
Practice Address - Street 1:3019 EDMONTON PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0135
Practice Address - Country:US
Practice Address - Phone:937-397-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator