Individual
LARRY GLEN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
993 D JOHNSON FERRY RD, STE 440, ATLANTA, GA 30342
(404) 257-0799
(404) 503-2280
Mailing address
993 D JOHNSON FERRY RD, STE 440, ATLANTA, GA 30342
(404) 257-0799
(404) 503-2280
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
052357
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000709497H
MEDICAID PROVIDER NUMBER
—
05
—
000981901A
—
GA
01
—
080685
BLUE CHOICE FAC INSURANCE
—
01
—
1422312
UNITED HEALTH CARE
—
01
—
1789
KAISER
—
01
—
2134940
AETNA HMO POS
—
01
—
52508068010
BLUE CHOICE PROVIDER ID
—
01
—
5433953006
CIGNA
—
01
—
5757428
AETNA MC PPO PIN NUMBER
—
01
—
REF000087396
MEDICAID REFERENCE PROVID
—
Enumeration date
03/14/2006
Last updated
03/08/2012
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