Larry Glen Lewis, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

052357 Issued in GA

Practice address

993 D Johnson Ferry Rd
Ste 440
Atlanta, GA 30342

Phone

(404) 257-0799

Fax

(404) 503-2280

NPI assigned

Mar 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: llewis7467@choa.gadirect.net

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.

• Atlanta Pediatric Nutrition, Inc.

  • Pediatric Nutrition Registered Dietitian
  • Woodstock, GA
  • NPI 1558096479
  NPD (past)
• Hospital Authority of the City of Bainbridge and Decatur County

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)
• Scottish Rite Children'S Medical Center

  • Pediatric Hematology & Oncology Physician
  • Atlanta, GA
  • NPI 1184779332
  NPD (past)
• Scottish Rite Childrens Medical Ctr

  • Children's Hospital
  • Atlanta, GA
  • NPI 1922178789
  NPD (past)
• The Childrens Center for Digestive Health Care LLC

  • Pediatric Gastroenterology Physician
  • Atlanta, GA
  • NPI 1457329989
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1699744722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "993 D JOHNSON FERRY RD",
            "address_2": "STE 440",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-257-0799",
            "fax_number": "404-503-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "993 D JOHNSON FERRY RD",
            "address_2": "STE 440",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-257-0799",
            "fax_number": "404-503-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "LARRY",
        "middle_name": "GLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "GA",
            "license": "052357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO POS",
            "identifier": "2134940",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5433953006",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID REFERENCE PROVID",
            "identifier": "REF000087396",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER NUMBER",
            "identifier": "000709497H",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE PROVIDER ID",
            "identifier": "52508068010",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000981901A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA MC PPO PIN NUMBER",
            "identifier": "5757428",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1422312",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE FAC INSURANCE",
            "identifier": "080685",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "1789",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Edward Lewis Jr., MD
• Kamryn Ruth Lewis
• Karen Renee Lewis
• Kendall Lewis, MD
• Kimberly S Lewis, DDS
• Lawyer Anthony Lewis
• Lela I Lewis, D.D.S.
• Lindsay Lewis
• Lynn Lewis, PT (ASCP)
• Malaysia Marie Lewis

• Pediatric Gastroenterology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.