Individual
NATHAN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
14000 HIGHWAY 82 W, ITTA BENA, MS 38941-1401
(334) 357-1543
Mailing address
2380 UNION GROVE RD, SWEET WATER, AL 36782-3934
(334) 357-1543
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8429747
DRIVERS LICENSE
AL
Enumeration date
11/30/2020
Last updated
07/21/2022
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