Provider Demographics
NPI:1457457426
Name:JOHNSON, LYNN BURTON (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:BURTON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6317
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6317
Mailing Address - Country:US
Mailing Address - Phone:478-750-2802
Mailing Address - Fax:478-745-1733
Practice Address - Street 1:3708 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2404
Practice Address - Country:US
Practice Address - Phone:478-750-2802
Practice Address - Fax:478-745-1733
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist