Phoeby K Lewis, DMD
Individual provider Active NPI General Practice Dentistry · Macon, GA
NPI 1154364396 · NPPES record last updated May 18, 2010
Key facts
- NPI
- 1154364396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN011094 (GA)
- Practice address
- 1536 Eisenhower Pkwy
Macon, GA 31206-3130 - Phone
- (478) 781-4333
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN011094 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Dental Professionals, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN011094 | GA | Yes |
Addresses
Primary practice location
1536 Eisenhower Pkwy
Macon, GA 31206-3130
Mailing address
201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (716) 562-4447
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 559750905A | Medicaid | GA | |
| 81635 | Other | GA | UNITED CONC. |
| 0007529 | Other | GA | DORAL |
| 100678 | Other | GA | AVESIS |
Other providers in Macon, GA
- Deidre Rene Lewis
- James H Lewis
- Lauren Elizabeth Lewis
- Mershel Elizabeth Lewis
- Natalie Latash Lewis
- Regina L Lewis
- Torrance R Lewis
- William S Lewis
- Ericka Vanesa Li Fuentes
- Gande Li
All providers in Macon, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.