Provider Demographics
NPI:1538170931
Name:STANLEY, LEWIS CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:CHRISTOPHER
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015
Mailing Address - Country:US
Mailing Address - Phone:229-271-4645
Mailing Address - Fax:229-271-4646
Practice Address - Street 1:910 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-271-4645
Practice Address - Fax:229-271-4646
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000506151EMedicaid
GA000506151FMedicaid
GA000506151DMedicaid
GA000506151DMedicaid
GA000506151EMedicaid