Provider Demographics
NPI:1598372732
Name:LYNCH-BERRY, DEBBIE DENISE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:DENISE
Last Name:LYNCH-BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 LORY LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-6104
Mailing Address - Country:US
Mailing Address - Phone:706-664-5284
Mailing Address - Fax:
Practice Address - Street 1:475 LORY LN
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-6104
Practice Address - Country:US
Practice Address - Phone:706-664-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010298163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health