Provider Demographics
NPI:1679063341
Name:LYPE, JAMES MATTHEW I
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:LYPE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-4003
Mailing Address - Country:US
Mailing Address - Phone:770-658-7455
Mailing Address - Fax:
Practice Address - Street 1:2335 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-4003
Practice Address - Country:US
Practice Address - Phone:770-658-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer