Healthcare Provider Details

I. General information

NPI: 1598242190
Provider Name (Legal Business Name): LYANNE COLON SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CURTIS PARKWAY 170 CURTIS PARKWAY NE SUITE 1
CALHOUN GA
30701
US

IV. Provider business mailing address

124 LAVENDER CIR
CALHOUN GA
30701-4849
US

V. Phone/Fax

Practice location:
  • Phone: 706-879-5770
  • Fax:
Mailing address:
  • Phone: 787-662-7692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number114669
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: