Provider Demographics
NPI:1912351586
Name:LYONS, OUIDA (MS)
Entity Type:Individual
Prefix:
First Name:OUIDA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5970
Mailing Address - Country:US
Mailing Address - Phone:256-652-3824
Mailing Address - Fax:
Practice Address - Street 1:3655 CANTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2690
Practice Address - Country:US
Practice Address - Phone:678-903-5197
Practice Address - Fax:678-903-5198
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management