Healthcare Provider Details

I. General information

NPI: 1174511638
Provider Name (Legal Business Name): ALEXANDER L LYONS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8902
US

IV. Provider business mailing address

4728 JENN DR SUITE 106
MYRTLE BEACH SC
29577-5714
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5800
  • Fax: 843-347-7469
Mailing address:
  • Phone: 843-839-9202
  • Fax: 843-467-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: