Provider Demographics
NPI:1104193606
Name:LEWIS, KEVIN J (RT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-0887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5434 EMILY CIR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4326
Practice Address - Country:US
Practice Address - Phone:404-784-8792
Practice Address - Fax:678-422-3857
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier