Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 788 | TN |
N | 222Z00000X | Podiatrist | 788 | TN |
Y | 213E00000X | Podiatrist | POD001344 | GA |
Y | 222Z00000X | Podiatrist | POD001344 | GA |
NPI | 1023458304 |
---|---|
Provider Name | Dr. Evan Michael Lewis |
First Address | Peachtree City, GA 30269-4794 |
Second Address | Canton, GA 30114-5295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 12/04/2019 |