1063472967 NPI number — JEFFERY DUN LEWIS MD

Table of content: JEFFERY DUN LEWIS MD (NPI 1063472967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063472967 NPI number — JEFFERY DUN LEWIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
JEFFERY
Provider Middle Name:
DUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063472967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
993D JOHNSON FERRY RD
Provider Second Line Business Mailing Address:
STE 440
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-257-0799
Provider Business Mailing Address Fax Number:
404-503-2280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
993D JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
STE 440
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-257-0799
Provider Business Practice Location Address Fax Number:
404-503-2280
Provider Enumeration Date:
03/24/2006

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: 2080P0206X , with the licence number:  041873 , 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: 2134940 . This is a "AETNA HMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1422312 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000709497H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52508068010 . This is a "BLUE CHOICE PROVIDER IDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5433953006 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5757428 . This is a "AETNA MC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080685 . This is a "BLUE CHOICE FAC INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1789 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




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