Individual
MARY CAROL LYTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
056132
GA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
056132
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10065021
AMERIGROUP
GA
01
—
349798
WELLCARE
GA
05
—
511379152A
—
GA
01
—
52172893-002
BCBS GA
GA
05
—
G56132
—
SC
Enumeration date
06/18/2006
Last updated
01/26/2022
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