Basic Information
| Provider Information | |||||||||
| NPI: | 1811045156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SUZAN | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741331 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134690503 | ||||||||
| FaxNumber: | 9134695267 | ||||||||
| Practice Location | |||||||||
| Address1: | NAVAL HOSPITAL | ||||||||
| Address2: | BUILDING H-100 SANTA MARGARITA ROAD | ||||||||
| City: | CAMP PENDLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607251400 | ||||||||
| FaxNumber: | 7607251267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 05-35689 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.