1629307277 NPI number — DR. BRIAN NEIL LEWIS M.D.

Table of content: DR. BRIAN NEIL LEWIS M.D. (NPI 1629307277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629307277 NPI number — DR. BRIAN NEIL LEWIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
BRIAN
Provider Middle Name:
NEIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1629307277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3345 HIGHWAY 34 E
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SHARPSBURG
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30277-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-502-8005
Provider Business Mailing Address Fax Number:
770-502-1825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-9069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-284-6300
Provider Business Practice Location Address Fax Number:
678-284-6326
Provider Enumeration Date:
12/10/2009

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: 207Q00000X , with the licence number:  63487 , 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)