Provider Demographics
NPI:1053010256
Name:LEWIS, JEFFREY THOMAS JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 REGAL LN SUITE 200A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5804
Mailing Address - Country:US
Mailing Address - Phone:865-521-8050
Mailing Address - Fax:865-544-5816
Practice Address - Street 1:7680 DANNAHER DR.
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4052
Practice Address - Country:US
Practice Address - Phone:865-521-8050
Practice Address - Fax:865-544-5816
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064392363A00000X
TNPA6077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant