Individual
SHANELLE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4484 COVINGTON HWY, DECATUR, GA 30035
(347) 313-2205
Mailing address
5910 SHADOW ROCK DR, LITHONIA, GA 30058-3232
(347) 313-2205
Taxonomy
Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
07/11/2018
Last updated
07/13/2018
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