Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.094508 | OH |
Y | 208000000X | Pediatrician | 76750 | GA |
N | 208000000X | Pediatrician | E-10688 | AR |
NPI | 1003010976 |
---|---|
Provider Name | Brandi Lewis |
First Address | Kennesaw, GA 30144-4534 |
Second Address | Kennesaw, GA 30144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
221871001 | (05) | AR |