Provider Demographics
NPI:1104990795
Name:LEWIS, ANDRE CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:CHRISTOPHER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 INDUSTRIAL BLVD.
Mailing Address - Street 2:HOSPITALISTS AT FAIRVIEW PARK LLC
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-274-3925
Mailing Address - Fax:478-274-3663
Practice Address - Street 1:200 INDUSTRIAL BLVD.
Practice Address - Street 2:HOSPITALISTS AT FAIRVIEW PARK LLC
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-274-3925
Practice Address - Fax:478-274-3663
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I110783Medicare PIN
GA11SCCNCMedicare ID - Type UnspecifiedMEDICARE PROVIDER #