Provider Demographics
NPI:1336492727
Name:THADDEUS K LYNN, M.D., P.C.
Entity Type:Organization
Organization Name:THADDEUS K LYNN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:KEDRON
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-773-7419
Mailing Address - Street 1:8495 DUNWOODY PL
Mailing Address - Street 2:BUILDING 9, SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3321
Mailing Address - Country:US
Mailing Address - Phone:770-817-8423
Mailing Address - Fax:770-817-8424
Practice Address - Street 1:8495 DUNWOODY PL
Practice Address - Street 2:BUILDING 9, SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3321
Practice Address - Country:US
Practice Address - Phone:770-817-8423
Practice Address - Fax:770-817-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126235GMedicaid