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General NPI Number Information
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NPI Number | 1760894737
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Entity Type | Individual
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Provider Name | LYLE DRAKE AUD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 2080 NEWNAN CROSSING BLVD SUITE 300
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-955-0270
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Fax | 770-955-0271
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Provider Business Mailing Address
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Address Line | 1601 GEORGIAN PARK STE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-6968
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Country | US
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Telephone | 770-955-0270
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Fax | 770-955-0271
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD003964
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License Number State | GA
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