Provider Demographics
NPI:1750384574
Name:LEWIS, DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2260
Practice Address - Fax:423-857-2261
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 13286208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6701868Medicaid
TN3196656Medicaid
VA6701868Medicaid
TN3196656Medicaid