Individual
LEWIS PONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 W PONCE DE LEON AVE, DECATUR, GA 30030-2400
(770) 609-6976
Mailing address
4221 MEDLOCK MILL DR, SNELLVILLE, GA 30039-2720
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01251982
—
GA
Enumeration date
02/20/2020
Last updated
02/20/2020
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