Provider Demographics
NPI:1174511638
Name:LYONS, ALEXANDER L (CPO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:LYONS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 JENN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5714
Mailing Address - Country:US
Mailing Address - Phone:843-839-9202
Mailing Address - Fax:843-467-2560
Practice Address - Street 1:123 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8902
Practice Address - Country:US
Practice Address - Phone:843-347-5800
Practice Address - Fax:843-347-7469
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist