Provider Demographics
NPI:1447543970
Name:LEWIS, DEBRA DIANE (DO)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:555 JUSTIS DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4288
Practice Address - Country:US
Practice Address - Phone:423-783-7965
Practice Address - Fax:833-908-2073
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58004527207Q00000X
OH34.011210207Q00000X
TN3205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100320360Medicaid
OH0103055Medicaid