Provider Demographics
NPI:1174509145
Name:LYNN, WILLERT HOWARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLERT
Middle Name:HOWARD
Last Name:LYNN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-2055
Mailing Address - Country:US
Mailing Address - Phone:912-826-1220
Mailing Address - Fax:912-826-1216
Practice Address - Street 1:800 TOWNE PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5156
Practice Address - Country:US
Practice Address - Phone:912-826-1220
Practice Address - Fax:912-826-1216
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GAGA 47979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine