Provider Demographics
NPI:1568573871
Name:LYLE, CAROL A (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:LYLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:240 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7214
Mailing Address - Country:US
Mailing Address - Phone:678-284-9171
Mailing Address - Fax:770-506-7436
Practice Address - Street 1:240 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7214
Practice Address - Country:US
Practice Address - Phone:678-284-9171
Practice Address - Fax:770-506-7436
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-27
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Provider Licenses
StateLicense IDTaxonomies
GA0247072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00532012BMedicaid
GA00532012BMedicaid
GAD45973Medicare UPIN