Individual
DEMETRIUS VINDE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1314 PAGODA DR, COLUMBUS, GA 31907-4439
(706) 593-8727
Mailing address
1314 PAGODA DR, COLUMBUS, GA 31907-4439
(706) 593-8727
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LPN052272
GA
376G00000X
Nursing Home Administrator
Primary
NIIA005224
GA
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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