Individual
JOHN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
810 W FOREST AVE, JACKSON, TN 38301-3942
(731) 668-1853
(731) 664-7731
Mailing address
810 W FOREST AVE, JACKSON, TN 38301-3942
(731) 668-1853
(731) 664-7731
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10103
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3626177
—
TN
Enumeration date
09/27/2005
Last updated
02/14/2012
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