Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 043236 | GA |
NPI | 1245241975 |
---|---|
Provider Name | Dr. Arlene Annetta Lewis |
First Address | Conyers, GA 30012-3882 |
Second Address | Conyers, GA 30012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 25/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65068 | (02) |