Provider Demographics
NPI:1750771572
Name:LYONS, KIMBERLY (RD, LD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 RIVER NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:544 MULBERRY ST STE 902
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8262
Practice Address - Country:US
Practice Address - Phone:478-207-7821
Practice Address - Fax:478-330-5592
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered