Provider Demographics
NPI:1477578599
Name:LYNCH, JONATHAN P (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-3141
Mailing Address - Country:US
Mailing Address - Phone:229-377-2002
Mailing Address - Fax:229-377-0930
Practice Address - Street 1:1178 5TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3141
Practice Address - Country:US
Practice Address - Phone:229-377-2002
Practice Address - Fax:229-377-0930
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL27868207Q00000X
GA060402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA124633161AMedicaid
SC278684Medicaid
GA511I080393Medicare PIN
SCRES0001124Medicare PIN
SCRES000Medicare UPIN