Provider Demographics
NPI:1124213715
Name:LIN, TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 POINTE NORTH DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7952
Mailing Address - Country:US
Mailing Address - Phone:678-721-0705
Mailing Address - Fax:678-721-5116
Practice Address - Street 1:21 POINTE NORTH DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7952
Practice Address - Country:US
Practice Address - Phone:678-721-0705
Practice Address - Fax:678-721-5116
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060401207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA884429229EMedicaid
GA884429229AMedicaid
GA884429229CMedicaid
GA884429229BMedicaid
GA884429229DMedicaid
GA884429229BMedicaid