Provider Demographics
NPI:1205031895
Name:LYTLE, NATHANIEL WYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:WYNN
Last Name:LYTLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 JOHNSON FY RD NE STE 180
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1795
Mailing Address - Country:US
Mailing Address - Phone:404-250-6691
Mailing Address - Fax:404-250-8847
Practice Address - Street 1:1100 JOHNSON FY RD NE STE 180
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1795
Practice Address - Country:US
Practice Address - Phone:404-250-6691
Practice Address - Fax:404-250-8847
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA67501208600000X
GA067501208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery