Provider Demographics
NPI:1699367649
Name:ADAMS, LYNNETTE
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:ADAMS
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 1:3536 WALSTINE LN
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7762
Mailing Address - Country:US
Mailing Address - Phone:229-300-9665
Mailing Address - Fax:
Practice Address - Street 1:3536 WALSTINE LN
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7762
Practice Address - Country:US
Practice Address - Phone:229-300-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor