Provider Demographics
NPI:1073800850
Name:SMITH, LYNN MCALUM (PA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MCALUM
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4042
Mailing Address - Country:US
Mailing Address - Phone:912-685-5073
Mailing Address - Fax:912-685-1197
Practice Address - Street 1:380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4042
Practice Address - Country:US
Practice Address - Phone:912-685-5073
Practice Address - Fax:912-685-1197
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant