Provider Demographics
NPI:1669467593
Name:LINCOLN, SALLY D (RD, LD, MSA)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:D
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:RD, LD, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 HILLDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1627
Mailing Address - Country:US
Mailing Address - Phone:706-660-0100
Mailing Address - Fax:
Practice Address - Street 1:107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4137
Practice Address - Country:US
Practice Address - Phone:706-845-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered