Basic Information
| Provider Information | |||||||||
| NPI: | 1528034832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 HARMON AVE STE 1D03 | ||||||||
| Address2: | WINN ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124355965 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1061 HARMON AVE STE 1D03 | ||||||||
| Address2: | WINN ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124355965 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME72401 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000665893C | 05 | GA | MEDICAID | 2501911-00 | 05 | FL | MEDICAID | 160030994 | 01 | FL | RAILROAD MEDICARE | OTHER | 31455 | 05 | FL | MEDICAID |