Individual
KENNETH BRYANT LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1841 QUIET CV, FAYETTEVILLE, NC 28304-3985
(910) 323-2626
Mailing address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 615-5095
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2018-02509
NC
208D00000X
General Practice Physician
5101022678
MI
390200000X
Student in an Organized Health Care Education/Training Program
2018-02509
NC
Other
Enumeration date
06/16/2016
Last updated
08/18/2025
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