Healthcare Provider Details

I. General information

NPI: 1770973992
Provider Name (Legal Business Name): LYONELL BENN-IZAK KONE MD, MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

461 LORIDANS DR NE
ATLANTA GA
30342-3405
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-4118
  • Fax:
Mailing address:
  • Phone: 443-769-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number100729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: