Individual
KANYA MONTAVIUS LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5440 PEACHTREE BLVD, CHAMBLEE, GA 30341-2255
(229) 338-9491
Mailing address
3335 TWIN FLOWER RD, ALBANY, GA 31701-7511
(229) 338-9491
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000050191
GA
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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