Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 080683 | GA |
Y | 208600000X | Surgeon | 080683 | GA |
NPI | 1003256983 |
---|---|
Provider Name | Austin J Lewis |
First Address | Carrollton, GA 30117-3858 |
Second Address | Carrollton, GA 30117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 09/04/2020 |