Individual
GWENDOLYN JEANETTE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(423) 664-4460
(423) 648-5675
Mailing address
902 MCCALLIE AVE, CHATTANOOGA, TN 37403-2724
(423) 664-4460
(423) 648-5675
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
RN120677
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN126077
LICENSE
GA
Enumeration date
01/23/2012
Last updated
01/23/2012
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