Provider Demographics
NPI:1871983940
Name:LEWIS, GINNA ASHLEY (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:GINNA
Middle Name:ASHLEY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-7000
Mailing Address - Country:US
Mailing Address - Phone:540-241-1664
Mailing Address - Fax:
Practice Address - Street 1:400 ATLANTIC CHRISTIAN COL DR NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2575
Practice Address - Country:US
Practice Address - Phone:540-241-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-21322255A2300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer