Healthcare Provider Details

I. General information

NPI: 1144228842
Provider Name (Legal Business Name): CAROL P LYERLY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 ELM ST
CUMMING GA
30040-2467
US

IV. Provider business mailing address

PO BOX 307
CUMMING GA
30028-0307
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-1668
  • Fax: 770-781-9937
Mailing address:
  • Phone: 770-887-1668
  • Fax: 770-781-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN116155 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: