Provider Demographics
NPI:1699317982
Name:LEWIS, ZODIE ANN (ADMIN ASS/ CNA)
Entity type:Individual
Prefix:
First Name:ZODIE
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ADMIN ASS/ CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-9513
Mailing Address - Country:US
Mailing Address - Phone:229-402-7637
Mailing Address - Fax:
Practice Address - Street 1:6 E GATE DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-9513
Practice Address - Country:US
Practice Address - Phone:229-402-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000054770376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide