Provider Demographics
NPI:1548232176
Name:HYLAND, LYNN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:JAMES
Last Name:HYLAND
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 1:1790 MULKEY RD
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1122
Mailing Address - Country:US
Mailing Address - Phone:770-739-6045
Mailing Address - Fax:770-739-6031
Practice Address - Street 1:1790 MULKEY RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1122
Practice Address - Country:US
Practice Address - Phone:770-739-6045
Practice Address - Fax:770-739-6031
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000342823BMedicaid
GA02BDBMTMedicare ID - Type Unspecified
GA000342823BMedicaid