1669421434 NPI number — BROOKE HANAWAY LEWIS MD

Table of content: BROOKE HANAWAY LEWIS MD (NPI 1669421434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669421434 NPI number — BROOKE HANAWAY LEWIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
BROOKE
Provider Middle Name:
HANAWAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANAWAY
Provider Other First Name:
BROOKE
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669421434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2970 BRANDYWINE RD STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-5521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-256-2593
Provider Business Mailing Address Fax Number:
770-488-9408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 RIVERSTONE TER STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-213-8942
Provider Business Practice Location Address Fax Number:
770-213-4158
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  055951 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 780942438A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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