Organization
SHILOH MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY HARRIS LEWIS D.P.M. (OWNER SOLO PRACTITIONER)
(770) 733-7560
Entity
Organization
Contact information
Practice address
1029 N PEACHTREE PKWY, STE 203, PEACHTREE CITY, GA 30269-4210
(770) 733-7560
Mailing address
1029 N PEACHTREE PKWY, STE#203, PEACHTREE CITY, GA 30269-4210
(770) 733-7560
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
POD001018
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131408692A
—
GA
Enumeration date
07/31/2006
Last updated
05/17/2016
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