Individual
JOHNNIE LYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.B.A.
Contact information
Practice address
2908 OAK LAKE BLVD, SUITE 205, CHARLOTTE, NC 28208-7703
(704) 567-8233
Mailing address
2908 OAK LAKE BLVD, SUITE 205, CHARLOTTE, NC 28208-7703
(704) 567-8233
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2009-00568
NC
208D00000X
General Practice Physician
Primary
2009-00568
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841491370
UNITED HEALTH CARE
NC
05
—
1841491370
—
NC
01
—
7014253
CIGNA
NC
Enumeration date
05/31/2007
Last updated
06/17/2016
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