Provider Demographics
NPI:1922110956
Name:MCKINNON, LYNDA M (MD CM)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:M
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MD CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1529
Mailing Address - Country:US
Mailing Address - Phone:864-332-3098
Mailing Address - Fax:855-232-3959
Practice Address - Street 1:2001 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1529
Practice Address - Country:US
Practice Address - Phone:864-332-3098
Practice Address - Fax:855-232-3959
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18284OtherMEDICAL LICENSES
SC182849Medicaid
G23014Medicare UPIN
SCG230146260Medicare ID - Type Unspecified