MEDICARE: MAURICE KIRKSEY LYONS CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	194015	GA

General Provider Information

NPI Number	:	1366333759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICE KIRKSEY LYONS CSFA

Provider Business Mailing Address
First Line	:	6027 ARMOR DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6244
Country	:	US
Telephone Number	:	678-368-5178
Fax Number	:

Provider Business Practice Location Address
First Line	:	6027 ARMOR DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6244
Country	:	US
Telephone Number	:	678-368-5178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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