Individual
NICOLE ALICIA LYTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(478) 464-8134
Mailing address
503 SAINT MARLO DR, CENTERVILLE, GA 31028-8005
(478) 953-1345
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
3771
GA
363A00000X
Physician Assistant
Primary
3771
GA
Other
Enumeration date
03/08/2007
Last updated
05/07/2024
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