Healthcare Provider Details

I. General information

NPI: 1245385855
Provider Name (Legal Business Name): LYDIA LEE DALEY PMHNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N. ANDERSON DRIVE
SWAINSBORO GA
30401
US

IV. Provider business mailing address

P O BOX 1259 223 N. ANDERSON DRIVE
SWAINSBORO GA
30401
US

V. Phone/Fax

Practice location:
  • Phone: 478-289-2530
  • Fax: 478-289-2532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN048295
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN048295
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: