Individual provider Active NPI

George Michael Lewis, PHARMD

  • Pharmacist
  • Brunswick, GA
National Provider Identifier
1043418973
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH023638 Issued in GA
Practice address
5711 Altama Ave Ste J
Brunswick, GA 31525-2200
Phone
(912) 264-2622
Fax
(912) 264-1392
NPI assigned
Jul 3, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH023638 GA Primary

Addresses

Primary practice location

5711 Altama Ave Ste J
Brunswick, GA 31525-2200

Mailing address

212 McIntosh Ave
Saint Simons Island, GA 31522-1867
Phone (912) 638-4829

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RPH023638GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Pharmacy LLC Current Accepting new patients
Southeastern Pharmacy LLC Current Accepting new patients

Locations

5711 Altama Ave
Ste J
Brunswick, GA 31525
Phone (912) 264-2622

Interoperability endpoints

  • Direct secure messaging: pharmacist@altamapharmacy.libertysoftwaredirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043418973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 MCINTOSH AVE",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315221867",
            "telephone_number": "912-638-4829",
            "fax_number": "912-264-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5711 ALTAMA AVE STE J",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315252200",
            "telephone_number": "912-264-2622",
            "fax_number": "912-264-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "GEORGE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH023638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.