| Doctor Name: | DR. EBONY B. LEWIS |
| NPI Number: | 1245531821 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.P.M |
| License Number: | POD001241 |
| Business Practice Address: | 425 Forest Pkwy Suite #101 Forest Park, GA - 302972185 |
| Business Phone Number: | 4043639944 |
| Business Fax Number: | 4043639951 |
| Mailing Address: | 425 Forest Pkwy, Suite #101 FOREST PARK |
| State: | GA |
| Postal Code: | 302972185 |
| Phone Number: | 4043639944 |
| Fax Number: | 4043639951 |
| NPI Enumeration Date: | 11/12/2010 |
| NPI Last Update Date: | 02/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | POD001241 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |