Individual
CANDACE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3334 HIGHWAY 155, LOCUST GROVE, GA 30248-3513
(770) 305-7929
(770) 305-7969
Mailing address
1058 BEAR CREEK BLVD, HAMPTON, GA 30228-1849
(770) 707-0808
(770) 707-1580
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7062
GA
363AM0700X
Medical Physician Assistant
Primary
007062
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003214384A
—
GA
Enumeration date
05/28/2014
Last updated
05/16/2019
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