Provider Demographics
NPI:1235155961
Name:LIN, EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-686-8143
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-686-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2189132OtherUNITED HEALTHCARE
GA000942587BMedicaid
GA284165OtherBCBS
GA2840432OtherUS HEALTHCARE
GA020052169OtherRAILROAD MEDICARE
GAY 20020901OtherPHCS
GA020052169OtherRAILROAD MEDICARE
GA000942587BMedicaid