Provider Demographics
NPI:1508062399
Name:LYLES, GRAHAM WARNER (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:WARNER
Last Name:LYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NORTH POINTE COURT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3187
Mailing Address - Country:US
Mailing Address - Phone:336-274-4626
Mailing Address - Fax:336-274-7952
Practice Address - Street 1:8 NORTH POINTE COURT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3187
Practice Address - Country:US
Practice Address - Phone:336-274-4626
Practice Address - Fax:336-274-7952
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00075207W00000X
NCRTL140925207W00000X
NC140925207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCZR0000146Medicare UPIN