Basic Information
Provider Information
NPI: 1003010976
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEWIS
FirstName: BRANDI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ALEXANDER
OtherFirstName: BRANDI
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1180 ERNEST W BARRETT PKWY NW STE 102B
Address2:  
City: KENNESAW
State: GA
PostalCode: 301444534
CountryCode: US
TelephoneNumber: 6783542273
FaxNumber:  
Practice Location
Address1: 1180 ERNEST W BARRETT PKWY NW STE 102B
Address2:  
City: KENNESAW
State: GA
PostalCode: 30144
CountryCode: US
TelephoneNumber: 6783542273
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2007
LastUpdateDate: 09/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X76750GAY Allopathic & Osteopathic PhysiciansPediatrics 
208000000XE-10688ARN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X35.094508OHN Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
22187100105AR MEDICAID


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