Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | AT 0000001193 | TN |
NPI | 1578791299 |
---|---|
Provider Name | Adam Andres Lewis |
First Address | Antioch, TN 37013-3990 |
Second Address | Nashville, TN 37232-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 01/07/2009 |