Individual
MR. JACOB DWAYNE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8179 TRACE CT, RIVERDALE, GA 30274-4318
(470) 634-2692
Mailing address
1201 W PEACHTREE ST NW STE 2625, ATLANTA, GA 30309-3499
(470) 634-2692
(888) 816-8882
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
04/25/2024
Last updated
04/29/2024
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