Provider Demographics
NPI:1023458304
Name:LEWIS, EVAN MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MICHAEL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:770-716-8732
Mailing Address - Fax:770-487-1204
Practice Address - Street 1:147 REINHARDT COLLEGE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5295
Practice Address - Country:US
Practice Address - Phone:470-274-7763
Practice Address - Fax:770-213-4152
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN788213E00000X
GAPOD001344213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist