Healthcare Provider Details

I. General information

NPI: 1306700554
Provider Name (Legal Business Name): LYTO MARCIUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 SHENANDOAH DR NE
CALHOUN GA
30701-4749
US

IV. Provider business mailing address

411 SHENANDOAH DR NE
CALHOUN GA
30701-4749
US

V. Phone/Fax

Practice location:
  • Phone: 678-549-4681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN225568
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: