Provider Demographics
NPI:1154320661
Name:LIPPINCOTT, LINCOLN HAMMELL (MD)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:HAMMELL
Last Name:LIPPINCOTT
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 1:120 S ZETTEROWER AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4816
Mailing Address - Country:US
Mailing Address - Phone:912-681-7368
Mailing Address - Fax:912-681-3687
Practice Address - Street 1:120 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4816
Practice Address - Country:US
Practice Address - Phone:912-681-7368
Practice Address - Fax:912-681-3687
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051059207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00947262AMedicaid
GA00947262AMedicaid
GA04BDCKBMedicare ID - Type Unspecified