Provider Demographics
NPI:1285699934
Name:LEWTER, JERRY MADISON (RN)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:MADISON
Last Name:LEWTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 ASHFORD DUNWOODY RD NE
Mailing Address - Street 2:APT N
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1873
Mailing Address - Country:US
Mailing Address - Phone:678-404-2343
Mailing Address - Fax:
Practice Address - Street 1:3726 ASHFORD DUNWOODY RD NE
Practice Address - Street 2:APT N
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1873
Practice Address - Country:US
Practice Address - Phone:678-404-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158379163WP0200X, 163W00000X, 163WC0200X, 163WH0200X, 163WW0000X, 163WH0500X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN158379OtherRN LICENSE