Provider Demographics
NPI:1780221283
Name:KINGRY, LYDIA LEE
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LEE
Last Name:KINGRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 DENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:GA
Mailing Address - Zip Code:31790-3306
Mailing Address - Country:US
Mailing Address - Phone:229-392-4976
Mailing Address - Fax:
Practice Address - Street 1:3490 DENHAM RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:GA
Practice Address - Zip Code:31790-3306
Practice Address - Country:US
Practice Address - Phone:229-392-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program