Provider Demographics
NPI:1780665208
Name:CHIN, LINDA MAE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:CHIN
Suffix:
Gender:F
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:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0846
Mailing Address - Country:US
Mailing Address - Phone:706-494-1454
Mailing Address - Fax:706-494-1455
Practice Address - Street 1:1921 WHITTLESEY RD
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9213
Practice Address - Country:US
Practice Address - Phone:706-494-1454
Practice Address - Fax:706-494-1455
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000881427BMedicaid
GA000881427CMedicaid
GA08BBXBLMedicare PIN
H19660Medicare UPIN
GA000881427BMedicaid