Individual
MRS. STACIE S LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
384 RACETRACK RD, MCDONOUGH, GA 30252-1022
(678) 432-8811
Mailing address
384 RACETRACK RD, MCDONOUGH, GA 30252-1022
(678) 432-8811
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN201620
GA
363LG0600X
Gerontology Nurse Practitioner
RN201620
GA
Other
Enumeration date
12/11/2018
Last updated
12/11/2018
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