Provider Demographics
NPI:1285650515
Name:GLENN, LYNN E (NP, PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:E
Last Name:GLENN
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 TRAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7767
Mailing Address - Country:US
Mailing Address - Phone:803-707-2704
Mailing Address - Fax:803-536-0998
Practice Address - Street 1:904 MERRY ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3839
Practice Address - Country:US
Practice Address - Phone:706-721-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000341363L00000X
SC121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121OtherLICENSE NUMBER
GAGAA-NP000341OtherGA NP LICENSE NUMBER