Individual
KENNETH EUGENE LYDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
275 COLLIER RD NW, STE 500, ATLANTA, GA 30309-1709
(404) 605-2800
(404) 351-5983
Mailing address
275 COLLIER RD NW, STE 500, ATLANTA, GA 30309-1709
(404) 605-2800
(404) 351-5983
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
124797
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000925801P
—
GA
Enumeration date
06/16/2005
Last updated
05/16/2011
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