Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT002469 | GA |
Y | 213ES0000X | Sports Medicine | AT002469 | GA |
NPI | 1437730264 |
---|---|
Provider Name | Hailey Lewis |
First Address | Cleveland, GA 30528-1264 |
Second Address | Cleveland, GA 30528-1264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |