Provider Demographics
NPI:1093392805
Name:LOBIN, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LOBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5754
Mailing Address - Country:US
Mailing Address - Phone:323-633-7941
Mailing Address - Fax:
Practice Address - Street 1:674 MOUNT ZION RD STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1561
Practice Address - Country:US
Practice Address - Phone:323-633-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06209183374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner