Basic Information
| Provider Information | |||||||||
| NPI: | 1740379866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | CORNELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 UPPER RIVERDALE RD SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789040094 | ||||||||
| FaxNumber: | 6789040098 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 UPPER RIVERDALE RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789040094 | ||||||||
| FaxNumber: | 6789040098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 025217 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00307194B | 05 | GA | MEDICAID |