Provider Demographics
NPI:1841388782
Name:LIN, ABRAHAM K (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:K
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5 GRADY JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-6026
Mailing Address - Country:US
Mailing Address - Phone:912-489-6246
Mailing Address - Fax:912-489-6346
Practice Address - Street 1:5 GRADY JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-6026
Practice Address - Country:US
Practice Address - Phone:912-489-6246
Practice Address - Fax:912-489-6346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA068057207RI0011X, 207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I115371Medicare PIN
GA202I115371Medicare PIN