Provider Demographics
NPI:1609681204
Name:LEWIS, NEIL
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 YOUNG AVE UNIT 336
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5755
Mailing Address - Country:US
Mailing Address - Phone:901-659-6671
Mailing Address - Fax:
Practice Address - Street 1:2298 YOUNG AVE UNIT 336
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5755
Practice Address - Country:US
Practice Address - Phone:901-659-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver