Healthcare Provider Details

I. General information

NPI: 1104212711
Provider Name (Legal Business Name): WILLIAM BUCKLEY LYMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 PARK RD
CHARLOTTE NC
28210-8538
US

IV. Provider business mailing address

10650 PARK RD
CHARLOTTE NC
28210-8538
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-0575
  • Fax:
Mailing address:
  • Phone: 704-667-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number210170
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number65962
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number65962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: