Provider Demographics
NPI:1366416166
Name:LEWIS, JOSEPH R JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6801 RIVER RD
Mailing Address - Street 2:STE 301
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3352
Mailing Address - Country:US
Mailing Address - Phone:706-494-0694
Mailing Address - Fax:706-494-0695
Practice Address - Street 1:6801 RIVER RD
Practice Address - Street 2:STE 301
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3352
Practice Address - Country:US
Practice Address - Phone:706-494-0694
Practice Address - Fax:706-494-0695
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366416166OtherLEWIS NPI
GA000480939GMedicaid